Lacosamide Dialysability in Patients with Impaired Renal Function
Lacosamide is dialysable, and approximately 50% of lacosamide is removed from systemic circulation during a 4-hour hemodialysis session, therefore dose supplementation following hemodialysis should be considered. 1
Pharmacokinetics of Lacosamide in Renal Impairment
- Lacosamide is eliminated predominantly via the kidneys, with renal clearance accounting for approximately 30% of total body clearance in healthy individuals 1
- In patients with severe renal impairment, renal clearance decreases to approximately 11% of total body clearance 1
- Terminal half-life and systemic exposure increase with renal impairment, while total body clearance, renal clearance, and urinary excretion decrease 1
- Strong positive correlations exist between creatinine clearance, renal clearance, and urinary excretion of lacosamide 1
Dialysability of Lacosamide
- Approximately 50% of lacosamide is cleared from systemic circulation during a 4-hour hemodialysis session 1
- Pharmacokinetic studies have confirmed the clearance of lacosamide with dialysis 1, 2
- Even in patients with essentially no renal clearance, nonrenal clearance of lacosamide is still present (approximately 1.1 L/h) 1
Dosing Recommendations for Patients on Dialysis
- Dose supplementation following hemodialysis should be considered due to the significant removal of lacosamide during dialysis 1
- Therapeutic drug monitoring may be useful in patients with decreased renal function or on dialysis to optimize dosing 2
- In continuous renal replacement therapy (CRRT), lacosamide is also significantly removed, with a sieving coefficient of 0.8 reported during continuous venovenous hemofiltration (CVVH) 3
Considerations for Different Dialysis Modalities
- Hemodialysis has been well-studied and shown to remove approximately 50% of lacosamide 1
- Continuous renal replacement therapies like CVVH also demonstrate significant extracorporeal removal of lacosamide 4, 3
- Peritoneal dialysis may have lower removal efficacy compared to hemodialysis, requiring close monitoring for potential drug accumulation 5
Clinical Implications
- For patients on hemodialysis, administering lacosamide after dialysis sessions is recommended to prevent significant drug loss 1
- Patients with mild-to-moderate renal impairment do not require dose adjustment as total body clearance decreases by only approximately 20% 1
- Dose adjustment is required for patients with severe renal impairment 1
- Therapeutic drug monitoring should be considered for patients on dialysis to ensure optimal dosing 2
While lacosamide has predictable pharmacokinetics in patients with normal renal function, its clearance is significantly affected by dialysis, making post-dialysis supplementation an important consideration to maintain therapeutic levels.