Names and pronunciation
(la-koe′sa-mide) Vimpat
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Individual generic drug information
Extracted information for lacosamide only.
(la-koe′sa-mide) Vimpat
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Func. class.: Anticonvulsant, miscel- laneous
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Chem. class.: Functionalized amino acid Controlled Substance Schedule V
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ACTION: May act through action at sodium channels; exact action is unknown
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USES: Partial-onset seizures
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Extracted information for lacosamide only.
CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, children <18 yr, geriatric patients, aller- gies, cardiac/renal/hepatic disease, acute MI, atrial fibrillation/flutter, AV block, bradycardia, HF, dehydration, depres- sion, dialysis, hazardous activity, electro- lyte imbalance, heart failure, labor, PR prolongation, sick sinus syndrome, substance abuse, suicidal ideation, syn- cope, torsades de pointes
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SIDE EFFECTS CNS: Dizziness, syncope, tremor, drowsi- ness, fever, paresthesias, depression, fatigue, headache, suicidal ideation CV: Atrial fibrillation/flutter, bradycardia, orthostatic hypotension, palpitations EENT: Diplopia, blurred vision, tinnitus GI: Nausea, constipation, vomiting, hepa titis, diarrhea, dyspepsia HEMA: Anemia, neutropenia, agranulocy tosis INTEG: Rash, erythema, inj-site reaction, pruritus SYST: Drug reaction with eosinophilia, systemic symptoms (DRESS), Stevens- Johnson syndrome, toxic epidermal necrolysis
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INTERACTIONS • Increase: PR prolongation—β-blockers, calcium channel blockers, atazanavir, L dronedarone, digoxin, lopinavir, ritonavir • Increase: lacosamide effect—CY P2C19 inhibitors (fluconazole, isoniazid, miconazole) Drug/Lab Test Increase: LFTs
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Extracted information for lacosamide only.
DOSAGE AND ROUTES Adjunct therapy • Adult and adolescent ≥17 yr: PO 50 mg bid, may increase weekly by 100 mg bid to 200-400 mg/day; IV 50 mg bid, infuse over 30-60 min, may be increased by 100 mg/day weekly up to 200-400 mg/ day maintenance Monotherapy • Adult: PO 100 mg bid; may increase weekly by 100 mg/day in 2 divided doses, increase to 300-400 mg/day in 2 divided doses or 200-mg single loading dose then 12 hr later start 100 mg bid Renal/hepatic dose • Adult: PO/IV max 300 mg/day for mild to moderate hepatic disease or CCr ≤30 mL/min; do not use in severe hepatic disease; reduce dose in renal/hepatic dis ease in those who are taking strong CYP3A4, CYP2C9 inhibitors
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Available forms: Film-coated tabs 50, 100, 150, 200 mg; solution for injection IV 20-mL single-use vials (200 mg/20 mL); oral sol 10 mg/mL
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Administer: • Store PO products/IV vials at room temperature; sol is stable for 24 hr when mixed with compatible diluents in glass or PVC bags at room temperature PO route • Tablet: give without regard to meals • Oral sol: measure with calibrated mea- suring device IV route • May give undiluted or mixed in 0.9% NaCl, D5W, or LR • Infuse over 30-60 min • Do not use if discolored or if particu- lates are present; discard unused por- tions
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Extracted information for lacosamide only.
Assess: • Seizures: duration, type, intensity, pre cipitating factors • Renal function: albumin concentration • CV status: orthostatic hypotension, PR prolongation; monitor cardiac status throughout treatment; ECG prior to ther- apy (IV), AV block may occur • Mental status: mood, sensorium, affect, memory (long, short term), depres sion, suicidal ideation, psychologic depen dence • Serious skin reactions: discontinue product at first sign of rash • Pregnancy/breastfeeding: Pregnant patient should enroll in North American Antiepileptic Drugs Pregnancy Registry, 1-888-233-2334; use only if benefits out weigh fetal risk; do not breastfeed, excre tion unknown • Beers: avoid in older adults unless safer alternatives are unavailable; may cause ataxia, impaired psychomotor function
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Evaluate: • Therapeutic response: increased sei- zure control
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to discontinue product abruptly; to taper over 1 wk because seizures may occur • To report blurred vision, nausea, dizzi- ness, syncope; to avoid hazardous activi- ties until stabilized on product • To carry emergency ID stating product use • To notify prescriber of suicidal thoughts/ behaviors, syncope, cardiac changes • To report rash, fever, fatigue, yellowing of skin, eyes, dark urine; may be hyper- sensitivity reaction • To notify prescriber immediately if pregnancy is planned or suspected; to enroll in pregnancy registry at 888-233- 2334, www.aedpregnancyregistry.org • That interactions with other medica- tions may occur; to report all OTC, Rx medications, herbals and supplements taken; not to use with alcohol • To consult MedGuide for proper use, risks, and review with patient
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Extracted information for lacosamide only.
PHARMACOKINETICS Metabolized by liver; excreted by kid- neys, 40%; protein binding <15% PO: Peak 1-4 hr IV: Peak 30-60 min; half-life 13 hr
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Filter the extracted dose blocks for this individual drug.
Adjunct therapy
• Adult and adolescent ≥17 yr: PO 50 mg bid, may increase weekly by 100 mg bid to 200-400 mg/day; IV 50 mg bid, infuse over 30-60 min, may be increased by 100 mg/day weekly up to 200-400 mg/ day maintenance Monotherapy
Candidate age grouping · source page 747
Adjunct therapy
• Adult: PO 100 mg bid; may increase weekly by 100 mg/day in 2 divided doses, increase to 300-400 mg/day in 2 divided doses or 200-mg single loading dose then 12 hr later start 100 mg bid Renal/hepatic dose
Candidate age grouping · source page 747
Adjunct therapy
• Adult: PO/IV max 300 mg/day for mild to moderate hepatic disease or CCr ≤30 mL/min; do not use in severe hepatic disease; reduce dose in renal/hepatic dis ease in those who are taking strong CYP3A4, CYP2C9 inhibitors
Candidate age grouping · source page 747