What is the use of Lacosamide (Vimpat)?

From the Guidelines

Lacosamide is a viable 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, as supported by recent studies 1.

Key Points to Consider

• Lacosamide can be used alone or in combination with other antiepileptic drugs, and its mechanism of action involves selectively enhancing slow inactivation of voltage-gated sodium channels, which helps stabilize hyperexcitable neuronal membranes and inhibit repetitive neuronal firing 1.
• Common side effects of lacosamide include dizziness, headache, nausea, and double vision, and it is essential to note that the medication should not be stopped abruptly, as this may increase seizure frequency; dosage should be gradually reduced under medical supervision 1.
• The medication is available in both oral and intravenous formulations, making it versatile for different clinical situations, and patients with severe cardiac disease or AV block should use lacosamide with caution, as it may affect cardiac conduction 1.

Administration and Dosage

• The choice of administration route (oral versus parenteral) is at the discretion of the emergency physician, and there is a lack of evidence to support one route over the other in terms of preventing early recurrent seizure 1.
• Loading with antiepileptic medication is commonly done, but there is a lack of evidence to support or refute this practice, and the information may not be consistent with Food and Drug Administration (FDA) labeling 1.

Important Considerations

• Lacosamide has been studied extensively in painful diabetic neuropathy, but it was not approved for this indication by the FDA or the European Medicines Agency, and its safety and tolerability appear generally comparable to other medications approved for neuropathic pain 1.
• Small dose-related increases in the PR interval have been associated with lacosamide treatment, and patients with severe cardiac disease or AV block should use the medication with caution 1.

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