Lacosamide – VimpatR
Indication
Partial-Onset Seizures
Adjunctive therapy
Initial: 50 mg PO/IV q12hr
Increase by 100 mg/day qWeek
Maintenance: 200-400 mg/day PO divided q12hr
Mechanism of Action
Antiepileptic effects unknown; may slowly inactivate voltage-gated Na channels
Binds to collapsin response mediator protein-2 (CRMP-2), a phosphoprotein that is expressed mainly in the nervous system and is involved in neuronal differentiation and control of axonal outgrowth
Absorption
Bioavailability: ~100%
Peak plasma time: 1-4 hr
Distribution
Protein bound: <15%
Vd: 0.6 L/kg
Metabolism
By CYP2C19; major metabolite, O-desmethyl-lacosamide, is inactive
Elimination
Half-life: 13 hr
Excretion: Urine
Dialyzable: Yes (hemodialysis)
IV Preparation
May be administered without dilution or diluted in compatible solvents: NS; D5W; LR
IV Administration
Infuse over 30-60 min
Pregnancy category: C
Lactation: Unknown if distributed in breast milk; use caution
>10%
Dizziness (31%)
Headache (13%)
Diplopia (11%)
Nausea (11%)
1-10%
Vomiting (9%)
Ataxia (8%)
Blurred vision (8%)
Tremor (7%)
Nystagmus (5%)
Balance disorder (4%)
Diarrhea (4%)
Injection site discomfort (2.5%)
Depression (2%)
Memory impairment (2%)
Pruritus (2%)
Increased ALT (1%)
Local irritation (1%)
<1%
Anemia
Cerebellar syndrome
Dyspepsia
Hepatitis
Atrial fibrillation/flutter
Atrioventricular block
Mood changes
Muscle spasm
Hypoesthesia
Neutropenia
Xerostomia
Nephritis
Palpitation
Postmarketing Reports
Blood and lymphatic system disorders: Agranulocytosis
Cardiac disorders: Bradycardia
Psychiatric disorders: Hallucination
Skin and subcutaneous tissue disorders: Rash
Contraindications
Hypersensitivity
Cautions
FDA warning on potential suicidal behavior with antiepileptic drugs
Cardiac conduction disorder
Hepatic/renal impairment
Pregnancy
May impair ability to perform hazardous tasks
Withdraw gradually