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Lacosamide – Cardiac Monitoring — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersLacosamide – Cardiac MonitoringSCE Neurology

A 50-year-old man with epilepsy is started on lacosamide. His ECG before starting shows normal sinus rhythm. What cardiac monitoring is recommended with lacosamide?

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Correct answer: C — ECG before starting and after dose titration, due to risk of PR interval prolongation and cardiac conduction abnormalities

Lacosamide enhances slow inactivation of voltage-gated sodium channels and can prolong the PR interval on ECG, potentially causing AV block, particularly in patients with pre-existing cardiac conduction disease or on other PR-prolonging drugs. An ECG should be obtained before starting and after significant dose increases. It is generally well-tolerated but should be used with caution in patients with cardiac conduction abnormalities. A: Cardiac monitoring is recommended. C: Holter monitoring is excessive for routine use. D: Echocardiography is not required. E: Telemetry is not routinely needed.

Reference: Lacosamide SmPC; NICE NG217 (2025); BNF