Lacosamide

Actions

• Enhances slow inactivation of voltage-gated Na+ channels.

Metabolism

Hepatic

Enzymes involved

• CYP2C19

Elimination

Renal

Half-life

13 hours

Plasma protein binding

<15%

Important side-effects

Suicidal behavior and ideation.

Cardiac rhythm and conduction abnormalities.

Multiorgan hypersensitivity reactions.

Indications

Focal seizures with or without generalization.

Dosing recommendation

Start with 100 mg/day divided in two doses.

Increase by 100 mg after 1–2 weeks.

Target dose: 200–400 mg/day divided in 2 doses.

Renal impairment

A maximum dose of 300 mg per day is recommended for patients with severe renal impairment (creatinine clearance ≤30 mL/min)

Hepatic impairment

A maximum dose of 300 mg per day is recommended for patients with mild to moderate hepatic impairment. The pharmacokinetics of lacosamide has not been evaluated in severe hepatic impairment.