Indications
Lacosamide is an anti-epileptic medicine used to control partial-onset (focal) seizures, with or without spread to both sides of the brain, in adults and older children. It can be used on its own or added to other seizure medicines. It is also used as add-on treatment for primary generalised tonic-clonic seizures in some patients.
How It Works
Nerve cells in the brain send signals through tiny channels that let sodium in. During a seizure, these cells fire again and again in an uncontrolled way. Lacosamide makes the sodium channels slow to reopen (it enhances their “slow inactivation”), which calms over-active nerve cells and reduces seizures without blocking normal brain activity.
Dosage and Administration
Lacosamide is taken as prescribed. Treatment usually starts at a low dose, often 50 mg twice a day, and the doctor increases it step by step every week until seizures are controlled. Take it at the same times each day, with or without food, and swallow tablets whole with water. Do not stop suddenly, as this can bring on seizures; the doctor will reduce the dose slowly if it needs to stop. Lower doses are used in severe kidney or liver disease. In hospitals it may also be given into a vein by a doctor or nurse.
Interactions
- Other medicines that affect heart rhythm (PR interval), such as Carbamazepine, Lamotrigine, Pregabalin, beta blockers and some antiarrhythmics, can add to its effect on the heart.
- Strong enzyme inhibitors (for example Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) may raise its level, especially in people with kidney or liver problems.
- Enzyme inducers such as Rifampicin, Phenytoin and Carbamazepine may lower its level.
- Alcohol and other sedating medicines can increase dizziness and drowsiness.
Contraindications
- Allergy to Lacosamide or any ingredient.
- Known second or third degree heart block (a serious problem with the heart’s electrical conduction).
Side Effects
Common: dizziness, headache, double vision, nausea, vomiting, tiredness, unsteady walking, shaking and blurred vision. Less common: slow or irregular heartbeat, fainting, memory problems, mood changes and itching.
Get urgent medical help for fainting, a very slow or irregular heartbeat, chest pain, a severe skin rash with blistering or fever, swelling of the face or throat, or thoughts of harming yourself.
Pregnancy and Lactation
Information on use in pregnancy is limited. Do not stop treatment on your own if you become pregnant, as uncontrolled seizures can harm both mother and baby; talk to your doctor promptly. Lacosamide passes into breast milk, so breastfeeding should be discussed with the doctor.
Precautions and Warnings
- Tell your doctor about any heart rhythm problem, heart disease, kidney or liver disease.
- Like other seizure medicines, it may rarely cause low mood or suicidal thoughts; family members should watch for changes.
- It can cause dizziness and blurred vision; do not drive or use machines until you know how it affects you.
- An ECG may be advised before and during treatment in people with heart problems.
Overdose
Too much Lacosamide can cause severe dizziness, nausea, seizures, heart rhythm problems and loss of consciousness. Seek emergency medical help at once. Treatment is supportive and may include heart monitoring; dialysis can remove some of the drug.
Therapeutic Class
Anti-epileptic (anticonvulsant), functionalised amino acid.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.