lacosamide: clinical use

Prescribing considerations

• Confirm seizure classification, patient age and the licence of the intended formulation.
• Review cardiac disease, conduction abnormalities and medicines that affect conduction.
• Consider renal and hepatic function when selecting treatment.
• Discuss pregnancy planning and arrange specialist review when appropriate.
• Be alert to new or worsening myoclonic seizures.

Contraindications and cautions

• Hypersensitivity to lacosamide or a product excipient.
• Known second- or third-degree atrioventricular block.

Monitoring

• Seizure frequency and any change in seizure type.
• Dizziness, visual effects, gait disturbance, falls and adherence.
• Mood, suicidal ideation and behavioural change.
• ECG in patients with conduction disease, significant cardiac disease or relevant interacting medicines.
• Renal and hepatic function when clinically indicated.

Clinical pharmacology

Lacosamide enhances slow inactivation of voltage-gated sodium channels. Oral absorption is rapid and essentially complete, food does not materially affect absorption, protein binding is low, and elimination is predominantly urinary as unchanged lacosamide and metabolites.

Formulation and product differences

• Film-coated tablets may be taken with or without food.
• The selected syrup must be shaken and measured using its supplied device. It contains sorbitol, propylene glycol, aspartame, sodium and a parahydroxybenzoate preservative, and should not be refrigerated.
• The intravenous solution is a temporary alternative when oral administration is not feasible and is for single use.
• The selected syrup has different paediatric licensing for focal-onset seizures from the selected tablet and infusion products.

Solution for infusion

Route: Intravenous

Strengths: 10 mg/mL

Syrup

Route: Oral

Strengths: 10 mg/mL

Tablet

Route: Oral

Strengths: 50 mg, 100 mg, 150 mg, 200 mg