Lacosamide

Generic name: Lacosamide

Drug class: Antiepileptic (functionalized amino acid; voltage-gated sodium channel slow inactivation enhancer)

Dosage form: Tablets (50 mg, 100 mg), oral solution (10 mg/mL), injection (10 mg/mL)

Root of administration: Oral, intravenous

Dose: Initial 50 mg twice daily, titrate by 50 mg twice daily weekly to 200–400 mg/day in two divided doses (max 600 mg/day); adjust in renal/hepatic impairment; IV dosing equivalent to oral

Mechanism of action: Enhances slow inactivation of voltage-gated sodium channels to stabilize hyperexcitable neuronal membranes and may modulate collapsin response mediator protein-2 (CRMP-2)

Drug usage cases:

• Adjunctive therapy for focal (partial-onset) seizures with or without secondary generalization
• Monotherapy for partial-onset seizures (FDA-approved in certain regions)
• Neuropathic pain (off-label)
• Diabetic peripheral neuropathy (off-label)
• Trigeminal neuralgia (off-label)
• Fibromyalgia (off-label)
• Chronic pain syndromes (off-label)
• Migraine prophylaxis (off-label)
• Alcohol withdrawal seizures (off-label)

Drug contra indications:

• Hypersensitivity to lacosamide or any component of the formulation
• Second- or third-degree atrioventricular block
• Known cardiac conduction abnormalities predisposing to arrhythmias

Side effects:

• Dizziness
• Headache
• Nausea
• Diplopia
• Somnolence
• Fatigue
• Ataxia
• Tremor
• Vertigo
• Memory impairment
• Dysarthria
• Coordination abnormalities
• Blurred vision
• Peripheral edema
• Gastrointestinal disturbances (diarrhea, constipation)
• PR interval prolongation
• Arrhythmias
• Syncope
• Suicidal ideation and behavior
• Elevated liver enzymes
• Hypersensitivity reactions, including DRESS and multiorgan hypersensitivity
• Leukopenia, thrombocytopenia

Warnings:

• Suicidal thoughts and behavior: Monitor patients for worsening depression or suicidal ideation
• Cardiac conduction abnormalities: PR interval prolongation; obtain ECG in patients with conduction problems or on other AV-nodal blocking agents
• CNS depression: May impair ability to drive or operate machinery
• Multiorgan hypersensitivity: Discontinue if signs of DRESS or organ dysfunction occur
• Renal impairment: Dose adjustment recommended; monitor renal function
• Hepatic impairment: Use caution and consider lower doses; monitor liver enzymes
• Elderly: Increased risk of dizziness, ataxia, falls; start at lower doses
• Withdrawal: Taper gradually to minimize seizure risk

Use during pregnancy or breastfeeding: Pregnancy Category C. Animal studies have shown fetal malformations at high doses; use only if potential benefit outweighs risks. Monitor neonates for adverse reactions if used during pregnancy. Excreted in human milk; breastfeeding not recommended or consult healthcare provider; if lactation continues, monitor infant for sedation and feeding difficulties.