What is the use of Lacosamide (Vimpat)?

From the Guidelines

Lacosamide is a valuable anticonvulsant medication for treating partial-onset seizures in patients with epilepsy, with a recommended starting dose of 50 mg twice daily and a maximum dose of 400 mg per day. The medication works by selectively enhancing slow inactivation of voltage-gated sodium channels, which helps stabilize hyperexcitable neuronal membranes 1. This unique mechanism makes it valuable for patients who haven't responded well to other antiepileptic medications.

Key Points

• Lacosamide can be prescribed as monotherapy or as an adjunctive treatment alongside other antiepileptic drugs.
• Common side effects include dizziness, headache, nausea, and diplopia.
• Lacosamide is available in both oral and intravenous formulations, making it versatile for different clinical situations.
• Patients with severe hepatic or renal impairment may require dose adjustments.
• Regular monitoring of cardiac function is recommended as lacosamide can cause PR interval prolongation, particularly in patients with cardiac conduction problems or those taking other medications affecting cardiac conduction 1.

Clinical Considerations

• The choice of anticonvulsant agents has become wider with more drugs available over recent years, but there is a lack of robust, randomised, controlled evidence to support the choice of the optimal antiepileptic drug for the treatment of seizures in patients with brain tumours 1.
• Lacosamide may assume a larger role as an add-on treatment for patients whose seizure disorder is not controlled by monotherapy.
• Patients and caregivers should be instructed how to behave and whom to contact in case of recurrent seizures.

Administration

• Lacosamide has both oral and intravenous formulations available and safe, with loading dosages not studied 1.
• The tolerability profile of IV lacosamide is consistent with that of oral lacosamide, with adverse effects including dizziness, headache, back pain, somnolence, and injection site pain 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Lacosamide Efficacy

• Lacosamide has been shown to be effective in reducing seizure frequency in patients with partial-onset seizures, with median percent reductions in seizure frequency per 28 days from baseline to maintenance of 37.3% for lacosamide 400 mg/day and 37.8% for lacosamide 600 mg/day compared to 20.8% for placebo 2.
• The responder rates for lacosamide 400 mg/day and 600 mg/day were 38.3% and 41.2%, respectively, compared to 18.3% for placebo 2.
• Lacosamide has also been shown to be effective in reducing secondarily generalized tonic-clonic seizures, with median percent reductions in seizure frequency of 59.4% for lacosamide 400 mg/day and 93.0% for lacosamide 600 mg/day compared to 14.3% for placebo 2.

Lacosamide Safety and Tolerability

• The most common adverse events associated with lacosamide were dizziness, nausea, and vomiting, which were dose-related 2, 3, 4.
• Lacosamide was generally well tolerated in adult patients with partial-onset seizures, with most treatment-emergent adverse events being of mild or moderate severity 3, 4.
• The safety and tolerability profile of adjunctive lacosamide was similar to that observed in individual double-blind trials, with common adverse events including dizziness, nausea, and diplopia 4.

Lacosamide Monotherapy

• Lacosamide monotherapy has been shown to be effective and well tolerated in selected adult patients with partial-onset seizures who had achieved seizure freedom during lacosamide add-on therapy 5, 6.
• The median modal dose of lacosamide monotherapy was 500 mg/day, and the majority of patients achieved lacosamide monotherapy at some point during the study 5.
• The most common adverse events associated with lacosamide monotherapy were dizziness, headache, and nausea, which were similar to those observed in adjunctive therapy studies 5, 6.

Long-term Exposure and Safety

• Long-term exposure to lacosamide monotherapy was associated with a safety profile similar to that of adjunctive therapy studies, with most treatment-emergent adverse events being of mild or moderate severity 5.
• The majority of patients were receiving lacosamide monotherapy at 0,12, and 24 months, and 74.2% of patients had a ≥50% seizure reduction and 5.6% were seizure-free at 24 months 5.