From the Research
Lacosamide dosing in acute kidney injury (AKI) superimposed on chronic kidney disease (CKD) typically requires dose adjustment, with a recommended starting dose of 50-100 mg twice daily and titration based on clinical response and tolerability, as supported by the most recent study 1.
Key Considerations
- The maximum daily dose should generally not exceed 300 mg in severe kidney impairment (creatinine clearance <30 mL/min) 2.
- No loading dose is typically needed, but if clinically necessary, a 200 mg loading dose can be considered with careful monitoring.
- Dose adjustments should be made gradually, increasing by 50 mg twice daily every 1-2 weeks as tolerated.
- Lacosamide requires adjustment in kidney impairment because approximately 40% of the drug is excreted unchanged in urine, leading to drug accumulation in patients with reduced kidney function 2.
Monitoring and Adjustments
- Monitor patients closely for side effects including dizziness, headache, nausea, and diplopia.
- Serum drug levels may be helpful in guiding therapy, particularly in patients with fluctuating kidney function 3.
- Reassess dosing as kidney function changes, especially if the patient recovers from the acute kidney injury component.
Rationale
- The pharmacokinetics of lacosamide are significantly affected by renal impairment, with decreased total body clearance and increased terminal half-life in patients with severe renal impairment 2.
- Continuous renal replacement therapy can also affect lacosamide pharmacokinetics, leading to subtherapeutic concentrations and decreased overall antiepileptic drug exposure 3.
- Therefore, careful dose adjustment and monitoring are necessary to ensure effective and safe use of lacosamide in patients with AKI on CKD.