What are the side effects of Lacosamide (Vimpat)?

From the Guidelines

Lacosamide can cause several side effects, including dizziness, headache, and nausea, which are typically mild to moderate and occur in a significant portion of patients, as reported in a study published in 2024 1.

Common Side Effects

• Dizziness
• Headache
• Double vision
• Nausea
• Vomiting
• Fatigue These side effects are often dose-dependent, with higher doses more likely to cause problems, and most appear within the first few weeks of treatment, as noted in a study from 2008 1.

Serious Side Effects

• Changes in heart rhythm (particularly PR interval prolongation)
• Suicidal thoughts
• Severe skin reactions
• Allergic reactions Patients with pre-existing cardiac conditions should use lacosamide cautiously, as it may worsen heart rhythm problems, and doctors typically start with a low dose (50 mg twice daily) and gradually increase it to minimize side effects, as suggested by the evidence from 1.

Minimizing Side Effects

• Taking lacosamide with food can help reduce gastrointestinal side effects
• Gradually increasing the dose can help minimize side effects
• Patients should contact their healthcare provider immediately if they experience irregular heartbeat, mood changes, suicidal thoughts, severe skin rash, or signs of allergic reaction. The side effects of lacosamide are due to its mechanism of action, which involves stabilizing neuronal membranes through selective enhancement of slow inactivation of voltage-gated sodium channels, affecting both brain and cardiac tissue, as discussed in 1.

From the Research

Lacosamide Side Effects

• Common side effects of lacosamide include:
  • Dizziness 2, 3, 4
  • Headache 2, 3, 4
  • Drowsiness 2
  • Diplopia 2, 3, 4
  • Nausea 3, 4
  • Vomiting 3, 4
  • Fatigue 5
  • Sedation 5
• Less common side effects include:
  • Memory impairment 5
  • Weight gain 5
  • Rash 2, 5
  • Atrioventricular block 5
  • Hematotoxicity 2
  • Heart damage 2
  • Psychological symptoms 2
  • Suicide risk 2
  • Excessive laughing 5
• Rare side effects include:
  • Psychosis 3
  • Skin rashes 2

Effects on Depression and Anxiety

• Lacosamide may have a positive effect on depressive symptoms in patients with epilepsy, particularly in those with initial depressive symptoms 6
• There were no significant changes in anxiety symptoms following lacosamide treatment 6