Lacosamide Dosing for Pediatric Patients
For a 9-year-old child weighing 25 kg, the recommended intravenous lacosamide loading dose is 10 mg/kg (250 mg total), administered over 30-60 minutes, followed by maintenance dosing of 5-10 mg/kg/day divided into two doses.
Loading Dose
- The optimal initial or loading dose is 10 mg/kg based on pediatric status epilepticus data showing this dose was efficacious in 78% of children, with 44% achieving seizure freedom within 24 hours 1
- For this 25 kg child, this translates to 250 mg as the loading dose 1
- The loading dose should be administered intravenously over 30-60 minutes to minimize adverse effects 1, 2
Maintenance Dosing
- Maintenance dosing ranges from 5-10 mg/kg/day divided into two doses (approximately 125-250 mg per day for this child) 3, 4
- After the loading dose, typical maintenance is initiated at the lower end (5 mg/kg/day) and titrated upward based on clinical response 3, 4
- For this 25 kg child, start with 125 mg/day divided into two doses (approximately 60 mg twice daily), then titrate as needed 3, 4
Maximum Dosing Considerations
- Doses up to 10 mg/kg/day have been shown to be safe in pediatric patients without major adverse effects 3
- Some studies have used doses ranging up to 15.5 mg/kg/day in younger children with refractory epilepsy, though this is at the upper limit 4
- The average total amount administered within the first 24 hours in the status epilepticus study was 13.8 mg/kg 1
Age-Appropriate Use
- Lacosamide is FDA-approved for children aged 4 years and older for focal-onset seizures 5
- This 9-year-old patient falls well within the approved age range 5
- Pediatric efficacy has been extrapolated from adult data with appropriate weight-based dosing adjustments 5
Safety Profile
- The most common adverse effects include dizziness, headache, nausea, somnolence, and irritability, reported in approximately 33-39% of pediatric patients 3, 4, 2
- Bradycardia was observed in one patient in the status epilepticus study, so cardiac monitoring is prudent during IV administration 1
- Lacosamide has a favorable pharmacokinetic profile with low potential for drug interactions and an elimination half-life of approximately 13 hours 2
IV to Oral Conversion
- Patients can be effectively switched from IV to oral lacosamide at the same dosage when clinically appropriate 5
- The oral formulation is rapidly and completely absorbed with linear, dose-proportional pharmacokinetics 2
Common Pitfalls to Avoid
- Do not underdose: Seven of nine patients in the pediatric status epilepticus study received the full 10 mg/kg loading dose, which correlated with better efficacy 1
- Infuse slowly: Administer the IV loading dose over 30-60 minutes rather than as a rapid bolus to minimize adverse effects 1, 2
- Monitor cardiac function: Given the rare occurrence of bradycardia, maintain cardiac monitoring during IV administration 1