What are the side effects of Lacosamide?

Side Effects of Lacosamide

Lacosamide commonly causes dizziness, headache, somnolence, diplopia, nausea, and cardiovascular abnormalities, with most side effects being mild to moderate in severity. 1

Common Side Effects

• Central Nervous System Effects:

  • Dizziness is the most frequently reported side effect, occurring in significantly higher rates compared to placebo (RR 3.53) 2
  • Abnormal coordination (RR 6.12) is a significant concern that can affect daily functioning 2
  • Diplopia (double vision) is common (RR 5.29) and may impact quality of life 2
  • Headache, though reported, is not statistically more common than with placebo 2
  • Somnolence (drowsiness) may occur but is not significantly different from placebo in controlled studies 2

• Gastrointestinal Effects:

  • Nausea (RR 2.37) and vomiting (RR 3.49) are significantly associated with lacosamide use 2
  • These symptoms are typically transient and may improve with continued use 1

• Cardiovascular Effects:

  • Small dose-related increases in PR interval have been observed 3
  • Cardiac monitoring may be warranted, particularly in patients with pre-existing cardiac conditions 1

Less Common but Serious Side Effects

• Psychiatric Effects:

  • Psychological symptoms have been reported, including rare cases of drug-induced psychosis 4
  • No significant worsening of depression symptoms was observed in most patients; some patients with pre-existing depression (NDDI-E scores >15) showed improvement 5
  • No significant effect on anxiety symptoms has been documented 5

• Dermatological Effects:

  • Skin rashes have been reported, though less frequently than with some other antiepileptic drugs 1

• Hematological Effects:

  • Hematotoxicity has been reported in post-marketing surveillance 1

Effects on Driving Performance

• Lacosamide may impair driving ability due to its effects on the central nervous system 3
• The Japanese Ministry of Health, Labour and Welfare guideline includes lacosamide among medications that require evaluation for their effects on driving performance 3
• Patients should be counseled about potential impairment of driving ability, particularly during initiation or dose changes 3

Dosing Considerations

• Higher doses of lacosamide (400 mg/day) are associated with increased incidence of adverse effects compared to lower doses (200 mg/day) 2
• Treatment withdrawal due to adverse effects is more common with lacosamide than with placebo (RR 1.88) 2
• Adverse effects are generally dose-dependent, with higher rates at 400-600 mg/day compared to 200 mg/day 2

Special Populations

• Limited data exists on lacosamide use in pregnancy, though the general principle in epilepsy management is that seizure control takes priority over theoretical medication risks 6
• Patients with cardiac conduction disorders require careful monitoring due to potential PR interval prolongation 1

Clinical Recommendations

• Start with lower doses and titrate slowly to minimize adverse effects 2
• Monitor for neurological side effects, particularly dizziness and coordination problems 1
• Patients should be advised about potential driving impairment, especially during treatment initiation 3
• Be vigilant for rare but serious psychiatric symptoms, particularly in patients with pre-existing mental health conditions 4
• Consider cardiac monitoring in patients with known cardiac conduction abnormalities 1

Pitfalls to Avoid

• Failing to warn patients about potential driving impairment, which could lead to accidents 3
• Overlooking potential cardiac effects in susceptible patients 1
• Abrupt discontinuation, which may precipitate seizures 6
• Ignoring rare but serious psychiatric side effects 4