From the Guidelines
VIMPAT (lacosamide) has significant drug interactions, particularly with other central nervous system medications, that can affect its efficacy and increase the risk of adverse effects. The potential interactions with VIMPAT are crucial for healthcare providers to understand in order to manage patient care effectively.
Key Interactions
- Other anti-seizure medications like carbamazepine, phenytoin, or phenobarbital may reduce VIMPAT's effectiveness, potentially requiring dosage adjustments 1.
- Drugs that cause PR interval prolongation, such as beta-blockers, calcium channel blockers, and certain antiarrhythmics, can increase the risk of cardiac conduction problems when combined with VIMPAT.
- Alcohol can enhance side effects like dizziness, coordination problems, and drowsiness when taken with VIMPAT.
Considerations for Special Populations
- Patients with liver or kidney impairment may require dose adjustments due to altered drug metabolism and excretion.
Mechanism of Action
VIMPAT works by selectively enhancing slow inactivation of voltage-gated sodium channels in the brain, which can lead to compounded or altered effects when combined with medications affecting similar pathways. Given the potential for significant interactions, it is essential for healthcare providers to carefully review a patient's medication list and medical history before prescribing VIMPAT. Monitoring for adverse effects and adjusting dosages as necessary can help mitigate risks associated with drug interactions 1.
From the Research
Potential Drug Interactions with VIMPAT (Lacosamide)
- VIMPAT (lacosamide) is an antiepileptic drug that can interact with other medications, including antiepileptic drugs (AEDs) 2, 3, 4, 5, 6
- Concomitant use of VIMPAT with other AEDs that are strong inducers of cytochrome P450 metabolism, such as carbamazepine, phenobarbital, and phenytoin, may reduce the plasma concentrations of VIMPAT 3
- Patients taking VIMPAT with strong inducers may require a 30% higher dose to achieve the same plasma drug concentration 3
- Combination of VIMPAT with other AEDs, such as carbamazepine, lamotrigine, topiramate, gabapentin, and levetiracetam, may have synergistic or additive effects on seizure reduction 5
- Electrocardiogram monitoring is necessary when VIMPAT and carbamazepine are used together, as this combination may predispose to seizures, conduction abnormalities, and dysrhythmia 4
- VIMPAT has few clinically relevant drug-drug interactions, but significant interactions may occur with enzyme-inducer AEDs 6
- Therapeutic drug monitoring (TDM) of VIMPAT may be useful in patients taking enzyme-inducer AEDs, in patients with decreased renal function or on dialysis, and older adults 6
Specific Drug Interactions
- Carbamazepine: reduces VIMPAT plasma concentrations, may require higher dose of VIMPAT 3
- Phenobarbital: reduces VIMPAT plasma concentrations, may require higher dose of VIMPAT 3
- Phenytoin: reduces VIMPAT plasma concentrations, may require higher dose of VIMPAT 3
- Lamotrigine: additive or synergistic effects on seizure reduction when combined with VIMPAT 5
- Topiramate: additive or synergistic effects on seizure reduction when combined with VIMPAT, may increase plasma levels of VIMPAT 5
- Gabapentin: additive or synergistic effects on seizure reduction when combined with VIMPAT 5
- Levetiracetam: additive or synergistic effects on seizure reduction when combined with VIMPAT 5