Lacosamide

Drug Information: Lacosamide

Detailed information regarding Lacosamide, a medication commonly used in clinical settings. Lacosamide is an anticonvulsant drug used to treat partial-onset seizures in adults and children. It works by selectively enhancing slow inactivation of voltage-gated sodium channels, stabilizing hyperexcitable neuronal membranes and inhibiting repetitive neuronal firing, thus reducing seizure activity. It is available in oral and intravenous formulations.

Category

Neurological Drugs – Anticonvulsant

Mechanism of Action

Lacosamide’s mechanism of action differs from many other anticonvulsants. While many anticonvulsants affect fast inactivation of sodium channels, Lacosamide primarily enhances the slow inactivation of voltage-gated sodium channels. Voltage-gated sodium channels are crucial for the initiation and propagation of action potentials in neurons. By selectively enhancing slow inactivation, Lacosamide stabilizes hyperexcitable neuronal membranes. This means it preferentially binds to and inhibits sodium channels in neurons that are firing rapidly and repetitively, a characteristic of seizure activity. This prolonged inactivation reduces the availability of sodium channels to participate in the generation of subsequent action potentials, thereby dampening neuronal excitability and preventing the spread of seizure activity. Importantly, Lacosamide does not affect normal neuronal function to the same extent, contributing to its generally favorable side effect profile compared to some other anticonvulsants. Lacosamide also binds to collapsin response mediator protein-2 (CRMP-2), a phosphoprotein which is mainly expressed in the nervous system and involved in neuronal differentiation and control of axonal outgrowth. The clinical significance of Lacosamide binding to CRMP-2 has not been fully established.

Clinical Uses

Lacosamide is primarily used as an adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalization in patients with epilepsy. This means it’s often used in combination with other antiepileptic drugs when a single medication isn’t sufficient to control seizures. It’s approved for use in adults and children (4 years and older) with partial-onset seizures. Studies have shown Lacosamide to be effective in reducing seizure frequency and improving seizure control. It can be administered orally or intravenously, providing flexibility in clinical settings. In some cases, it is also used off-label for other neurological conditions involving pain, such as diabetic neuropathy. Its effectiveness and safety profile make it a valuable option in the management of epilepsy, although it’s crucial to tailor treatment to individual patient needs and seizure types.

Dosage

Adults:
* Oral: Typical starting dose is 50 mg twice daily. May be increased at weekly intervals by 50 mg twice daily, up to a maintenance dose of 100-200 mg twice daily (200-400 mg/day).
* IV: The intravenous dose is the same as the oral dose. For patients when oral administration is temporarily not feasible.

Pediatrics (4 years and older):
* Oral: The recommended starting dose is 1 mg/kg twice daily. The dose may be increased by 1 mg/kg twice daily every week. The target maintenance dose depends on body weight. Doses must be adjusted based on body weight, please refer to the prescribing information.
* IV: The intravenous dose is the same as the oral dose. For patients when oral administration is temporarily not feasible.

Indications

* Adjunctive therapy for partial-onset seizures (with or without secondary generalization) in adults and children 4 years and older.

Contraindications

* Known hypersensitivity to lacosamide or any of the inactive ingredients in the formulation.
* Patients with second- or third-degree atrioventricular (AV) block without a pacemaker.

FAQ

Q: What is Lacosamide used for?
A: Lacosamide is used to treat partial-onset seizures in adults and children 4 years and older.

Q: How does Lacosamide work?
A: Lacosamide works by selectively enhancing the slow inactivation of voltage-gated sodium channels in the brain, stabilizing hyperexcitable neuronal membranes and reducing seizure activity.

Q: What are the common side effects of Lacosamide?
A: Common side effects include dizziness, headache, nausea, vomiting, blurred vision, and fatigue.

Q: Can Lacosamide be used during pregnancy?
A: Lacosamide should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Consult with your doctor.

Q: Does Lacosamide interact with other medications?
A: Yes, Lacosamide can interact with other medications, especially other antiepileptic drugs and medications that affect heart rhythm. Discuss all medications you are taking with your doctor.

Q: How should Lacosamide be taken?
A: Lacosamide should be taken exactly as prescribed by your doctor. It can be taken with or without food. Do not stop taking Lacosamide abruptly without consulting your doctor, as this can increase the risk of seizures.

Q: What should I do if I miss a dose of Lacosamide?
A: If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up.

Q: Can Lacosamide cause mood changes or depression?
A: Yes, some people taking Lacosamide may experience mood changes, including depression or anxiety. Report any significant mood changes to your doctor immediately.