From the Research
The appropriate range for lacosamide is 200-400 mg/day, with some patients potentially benefiting from doses up to 600 mg/day in refractory cases, as supported by the study 1. The therapeutic range for lacosamide is typically achieved through a maintenance dose of 200-400 mg/day divided twice daily.
- Lacosamide is usually initiated at 50 mg twice daily and gradually titrated by 100 mg/day increments weekly to achieve the desired therapeutic range.
- The maximum recommended daily dose is 400 mg, though some patients may benefit from doses up to 600 mg/day in refractory cases, as seen in the study 1.
- Dose adjustments are necessary for patients with severe renal impairment (CrCl ≤30 mL/min) or hepatic impairment.
- Monitoring serum levels is particularly important when adjusting doses, adding interacting medications, or when toxicity is suspected.
- Lacosamide works by enhancing slow inactivation of voltage-gated sodium channels, which is distinct from traditional sodium channel blockers, providing a unique mechanism for seizure control with potentially fewer drug interactions than other antiepileptic medications, as described in the study 2.
- Long-term studies, such as 3 and 4, have demonstrated the safety and efficacy of lacosamide as adjunctive treatment for partial-onset seizures, with many patients achieving significant seizure reduction and maintaining efficacy over time.