What is the use of Lacosamide (Vimpat)?

From the Guidelines

Lacosamide is a valuable treatment option for partial-onset seizures in adults and children over 4 years of age with epilepsy, with a typical starting dose of 50 mg twice daily, gradually increasing to a maintenance dose of 100-200 mg twice daily 1. When considering the use of lacosamide, it is essential to weigh the benefits and risks, particularly in terms of its potential to prolong the PR interval in some patients 1. The medication can be administered orally or intravenously, and its efficacy and safety profile make it a suitable option for patients with drug-resistant epilepsy. Some key points to consider when using lacosamide include:

• Its mechanism of action, which involves selectively enhancing slow inactivation of voltage-gated sodium channels, helping to stabilize hyperexcitable neuronal membranes and inhibit repetitive neuronal firing 1
• Common side effects, such as dizziness, headache, nausea, and double vision 1
• The need for dose adjustments in patients with severe liver or kidney disease 1
• The importance of regular monitoring of cardiac function due to the potential for lacosamide to prolong the PR interval in some patients 1 Overall, lacosamide is a useful treatment option for partial-onset seizures, and its benefits and risks should be carefully considered in the context of individual patient needs and medical history.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Lacosamide Overview

• Lacosamide is a functionalized amino acid with a novel mode of action, selectively enhancing the slow inactivation of voltage-gated sodium channels 2
• It is available as oral or intravenous formulations, with bioequivalence established between the oral tablet and oral syrup 2

Efficacy in Partial-Onset Seizures

• Lacosamide has been shown to be effective in reducing seizure frequency in adult patients with uncontrolled partial-onset seizures, with or without secondary generalization 2, 3
• In a randomized controlled trial, lacosamide 400 mg/day and 600 mg/day significantly reduced seizure frequency compared to placebo, with responder rates of 38.3% and 41.2%, respectively 3
• Lacosamide has also been shown to be effective as monotherapy for partial onset seizures, with a retention rate of 63.8% and seizure freedom rate of 55.2% at 1 year 4

Safety and Tolerability

• Lacosamide is generally well tolerated, with most treatment-emergent adverse events being mild or moderate in severity 2, 5
• Common adverse events include dizziness, nausea, and diplopia, which are often dose-related 5
• The safety and tolerability profile of lacosamide is similar to that observed in individual double-blind trials, with a low incidence of serious adverse events 5

Clinical Use

• Lacosamide can be used as adjunctive therapy for partial-onset seizures, with a recommended dose of 400 mg/day 3
• It can also be used as monotherapy for partial onset seizures, with a similar efficacy and safety profile to adjunctive therapy 4
• Lacosamide has been shown to be effective and well tolerated as first add-on or later adjunctive treatment for uncontrolled partial-onset seizures 6