From the Research
When switching a patient from Keppra (levetiracetam) to Vimpat (lacosamide), a gradual transition is recommended to maintain seizure control, as supported by the most recent study 1 which demonstrated the equipotency of lacosamide to levetiracetam in new onset focal epilepsy.
Transition Protocol
To initiate the transition, start by adding Vimpat at 50 mg twice daily to the patient's current Keppra regimen.
- Increase Vimpat by 50 mg twice daily each week until reaching the target dose, typically 200-400 mg daily divided into two doses.
- Once the patient is on a therapeutic Vimpat dose for 1-2 weeks and showing stability, gradually taper Keppra by reducing the dose by about 500 mg every 1-2 weeks until discontinuation.
Rationale
This overlap period is crucial as it helps prevent breakthrough seizures during the transition, as both medications have different mechanisms of action - Vimpat enhances slow inactivation of sodium channels, while Keppra binds to synaptic vesicle protein SV2A, allowing them to work complementarily during the transition period 1.
Monitoring and Adjustments
Monitor the patient closely for side effects such as dizziness, headache, double vision, or nausea.
- Dose adjustments may be needed for patients with renal or hepatic impairment.
- The efficacy and tolerability of lacosamide as monotherapy have been shown to be comparable to levetiracetam in various studies, including a retrospective study 2 and a randomized controlled trial 1, supporting the use of lacosamide as a viable alternative to levetiracetam.