THERAPEUTICS

Brands

• Vimpat

Generic?

• No

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Partial seizures in patients 17 years or older (monotherapy and adjunctive therapy)

• Status epilepticus

• Myoclonus

• Diabetic neuropathic pain

How the Drug Works

• Lacosamide likely acts by enhancing slow inactivation of voltage-gated sodium channels, resulting in stabilization of hyperexcitable neuronal membranes and inhibition of repetitive neuronal firing

• It also binds to collapsin response mediator protein-2 (CRMP-2), which causes changes in axon outgrowth

• Unlike many AEDs, does not appear to affect AMPA, kainate, NMDA, or GABA receptors and does not block potassium or calcium currents

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy

If It Doesn't Work

• Increase to highest tolerated dose

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Epilepsy: designed for use with other AEDs. No interactions with AEDs in terms of levels but risk of AEs and hepatic dysfunction increase with polytherapy

Tests

• No regular blood tests are recommended

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• CNS AEs are mostly related to changes in sodium channel function

Notable AEs

• Dizziness, ataxia, vomiting, diplopia, nausea, vertigo, blurry vision, and tremor are most common. Palpitations, dry mouth, tinnitus, paresthesias are less common. Injection site pain and erythema with IV administration

• Increase in hepatic transaminases in about 0.7% of patients. More common in patients on multiple AEDs

Life-Threatening or Dangerous AEs

• Hepatitis, neutropenia (both rare)

• Risk of behavioral or mood effects including depression, suicidal ideation