From the Research
Lacosamide should be tapered gradually when discontinuing to minimize the risk of seizure recurrence or withdrawal symptoms, with a typical taper schedule involving reducing the dose by 50-100 mg per week. For example, if a patient is on 200 mg twice daily (400 mg total daily dose), the taper might proceed as follows: 300 mg daily for one week, then 200 mg daily for one week, then 100 mg daily for one week, then discontinue 1. The taper rate may need to be slower for patients who have been on higher doses or taking the medication for longer periods. Patients should be monitored for breakthrough seizures during the tapering process. The gradual reduction allows the brain to adjust to decreasing levels of the medication, as abrupt discontinuation can lead to increased neuronal excitability and seizure threshold lowering. Factors that might necessitate a slower taper include history of difficult-to-control epilepsy, prior withdrawal seizures, or concomitant reduction of other antiseizure medications. Throughout the taper, patients should continue other prescribed antiseizure medications without changes and maintain regular sleep patterns and stress management to reduce seizure risk.
Some key points to consider when tapering lacosamide include:
- The risk of adverse events, such as dizziness, headache, nausea, and diplopia, which were commonly reported in clinical trials 2
- The potential for drug interactions, particularly with other antiepileptic drugs, which may affect the taper schedule 3
- The importance of monitoring seizure frequency and adjusting the taper schedule as needed to minimize the risk of seizure recurrence 4
- The need for individualized taper schedules, taking into account the patient's specific clinical situation and medical history 5
Overall, a gradual taper of lacosamide, with careful monitoring and adjustment as needed, is recommended to minimize the risk of seizure recurrence or withdrawal symptoms and ensure the best possible outcome for patients.