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Vimpat
lacosamide
Adult Dosing .
Dosage forms: TAB: 50 mg, 100 mg, 150 mg, 200 mg; SOLUTION: 10 mg per mL; INJ: various
partial seizures
- [monotherapy]
- Dose: 150-200 mg PO/IV bid; Start: 100 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, incr. by 100 mg/day no more frequently than qwk; Max: 400 mg/day; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; titrate with caution in elderly patients; taper dose over >1wk to D/C
- [adjunct tx]
- Dose: 100-200 mg PO/IV bid; Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, may incr. by 100 mg/day no more frequently than qwk; Max: 400 mg/day; Info: titrate with caution in elderly patients; taper dose over >1wk to D/C
primary generalized tonic clonic seizures, adjunct tx
- [100-200 mg PO/IV bid]
- Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, may incr. by 100 mg/day no more frequently than qwk; Max: 400 mg/day; Info: titrate with caution in elderly patients; taper dose over >1wk to D/C
neuropathic pain, diabetic (off-label)
- [100-200 mg PO bid]
- Start: 50 mg PO bid x3wk, incr. by 100 mg/day qwk; Max: 400 mg/day; Info: titrate with caution in elderly patients; taper dose over >1wk to D/C
renal dosing
- [adjust dose amount]
- CrCl <30: decr. usual max dose by 25%
- HD: decr. usual max dose by 25%; give up to 50% usual dose as supplement after dialysis; PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: decr. usual max dose by 25%; severe impairment: avoid use
Peds Dosing .
- Dosage forms: TAB: 50 mg, 100 mg, 150 mg, 200 mg; SOLUTION: 10 mg per mL; INJ: various
partial seizures, monotherapy
- [PO route, 1 mo-16 yo, <6 kg]
- Dose: 3.75-7.5 mg/kg/dose PO bid; Start: 1 mg/kg/dose PO bid, incr. by 2 mg/kg/day no more frequently than qwk or start 3.75 mg/kg/dose PO bid, may incr. by 2 mg/kg/day no more frequently than qwk; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; taper dose over >1wk to D/C
- [IV route, 1 mo-16 yo, <6 kg]
- Dose: 2.5-5 mg/kg/dose IV tid; Start: 0.66 mg/kg/dose IV tid, incr. by 2 mg/kg/day no more frequently than qwk or start 2.5 mg/kg/dose IV tid, may incr. by 2 mg/kg/day no more frequently than qwk; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; taper dose over >1wk to D/C
- [1 mo-16 yo, 6-30 kg]
- Dose: 3-6 mg/kg/dose PO/IV bid; Start: 1 mg/kg/dose PO/IV bid, incr. by 2 mg/kg/day no more frequently than qwk or start 4.5 mg/kg/dose PO/IV x1, then 3 mg/kg/dose PO/IV bid 12h later, may incr. by 2 mg/kg/day no more frequently than qwk; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; taper dose over >1wk to D/C
- [1 mo-16 yo, 30-50 kg]
- Dose: 2-4 mg/kg/dose PO/IV bid; Start: 1 mg/kg/dose PO/IV bid, incr. by 2 mg/kg/day no more frequently than qwk or start 4 mg/kg/dose PO/IV x1, then 2 mg/kg/dose PO/IV bid 12h later, may incr. by 2 mg/kg/day no more frequently than qwk; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; taper dose over >1wk to D/C
- [1 mo-16 yo, >50 kg]
- Dose: 150-200 mg PO/IV bid; Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, incr. by 100 mg/day no more frequently than qwk; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; taper dose over >1wk to D/C
- [17 yo and older]
- Dose: 150-200 mg PO/IV bid; Start: 100 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, incr. by 100 mg/day no more frequently than qwk; Max: 400 mg/day; Info: for conversion from AED monotherapy, give lacosamide maintenance dose for >3 days before gradual withdrawal of previous AED over >6wk; taper dose over >1wk to D/C
partial seizures, adjunct tx
- [PO route, 1 mo-16 yo, <6 kg]
- Dose: 3.75-7.5 mg/kg/dose PO bid; Start: 1 mg/kg/dose PO bid, incr. by 2 mg/kg/day no more frequently than qwk or start 3.75 mg/kg/dose PO bid, may incr. by 2 mg/kg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [IV route, 1 mo-16 yo, <6 kg]
- Dose: 2.5-5 mg/kg/dose IV tid; Start: 0.66 mg/kg/dose IV tid, incr. by 2 mg/kg/day no more frequently than qwk or start 2.5 mg/kg/dose IV tid, may incr. by 2 mg/kg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [1 mo-16 yo, 6-30 kg]
- Dose: 3-6 mg/kg/dose PO/IV bid; Start: 1 mg/kg/dose PO/IV bid, incr. by 2 mg/kg/day no more frequently than qwk or start 4.5 mg/kg/dose PO/IV x1, then 3 mg/kg/dose PO/IV bid 12h later, may incr. by 2 mg/kg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [1 mo-16 yo, 30-50 kg]
- Dose: 2-4 mg/kg/dose PO/IV bid; Start: 1 mg/kg/dose PO/IV bid, incr. by 2 mg/kg/day no more frequently than qwk or start 4 mg/kg/dose PO/IV x1, then 2 mg/kg/dose PO/IV bid 12h later, may incr. by 2 mg/kg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [1 mo-16 yo, >50 kg]
- Dose: 100-200 mg PO/IV bid; Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, may incr. by 100 mg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [17 yo and older]
- Dose: 100-200 mg PO/IV bid; Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, may incr. by 100 mg/day no more frequently than qwk; Max: 400 mg/day; Info: taper dose over >1wk to D/C
primary generalized tonic clonic seizures, adjunct tx
- [4-16 yo, 11-30 kg]
- Dose: 3-6 mg/kg/dose PO/IV bid; Start: 1 mg/kg/dose PO/IV bid, incr. by 2 mg/kg/day no more frequently than qwk or start 4.5 mg/kg/dose PO/IV x1, then 3 mg/kg/dose PO/IV bid 12h later, may incr. by 2 mg/kg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [4-16 yo, 30-50 kg]
- Dose: 2-4 mg/kg/dose PO/IV bid; Start: 1 mg/kg/dose PO/IV bid, incr. by 2 mg/kg/day no more frequently than qwk or start 4 mg/kg/dose PO/IV x1, then 2 mg/kg/dose PO/IV bid 12h later, may incr. by 2 mg/kg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [4-16 yo, >50 kg]
- Dose: 100-200 mg PO/IV bid; Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, may incr. by 100 mg/day no more frequently than qwk; Info: taper dose over >1wk to D/C
- [17 yo and older]
- Dose: 100-200 mg PO/IV bid; Start: 50 mg PO/IV bid, incr. by 100 mg/day no more frequently than qwk or start 200 mg PO/IV x1, then 100 mg PO/IV bid 12h later, may incr. by 100 mg/day no more frequently than qwk; Max: 400 mg/day; Info: taper dose over >1wk to D/C
renal dosing
- [adjust dose amount]
- CrCl <30: decr. usual max dose by 25%
- HD: decr. usual max dose by 25%; give up to 50% usual dose as supplement after dialysis; PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: decr. usual max dose by 25%; severe impairment: avoid use
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hepatic impairment, severe
- abrupt withdrawal
- caution: CNS depressant use, concurrent
- caution: alcohol use, concurrent
- caution: elderly patients
- caution: hepatic impairment, mild-moderate
- caution: CrCl <30
- caution: cardiovascular disease
- caution: cardiac conduction disturbance
- caution: cardiac sodium channelopathy
- caution: Brugada syndrome
- caution: diabetic neuropathy
- caution: depression
- caution: depression history
- caution: PKU (phenylalanine-containing form)
Drug Interactions .
Overview
lacosamide
sodium channel blocker
- CYP2C9 substrate
- CYP3A4 substrate
- affected by altered fat absorption
- antiepileptic agent
- bradycardia
- CNS depression
- delays atrioventricular conduction
Contraindicated
- amifampridine
- bupropion
- dalfampridine
Avoid/Use Alternative
- brigatinib
- butalbital
- ceritinib
- clonidine
- codeine
- crizotinib
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- ethanol (alcoholic beverage)
- ethanol injection
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Monitor/Modify Tx
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Caution Advised
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Adverse Reactions .
Serious Reactions
- PR prolongation
- AV block
- bradycardia
- ventricular tachyarrhythmia
- atrial fibrillation
- atrial flutter
- syncope
- suicidality
- psychosis
- hypersensitivity reaction
- drug reaction with eosinophilia and systemic symptoms
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- withdrawal seizures if abrupt D/C
- neutropenia
- agranulocytosis
- abuse potential
Common Reactions
- dizziness
- somnolence
- headache
- nausea
- diplopia
- vomiting
- blurred vision
- paresthesia (IV use)
- abnormal gait
- fatigue
- ataxia
- tremor
- nystagmus
- vertigo
- diarrhea
- balance disorder
- pruritus
- injection site pain (IV use)
- asthenia
- depression
- dyskinesia
- myoclonic seizures
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; ECG at baseline if cardiac conduction disturbance, severe cardiac disease, or cardiac sodium channelopathy, then at steady state; signs/symptoms of depression, behavior changes, suicidality
Look/Sound-Alike Drug Names
Vimpat confused with: Venofer; Vfend
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; no known risk of teratogenicity, though risk of fetal death and decr. body wt based on animal data at 2x MRHD; possible risk of developmental neurotoxicity based on animal data and drug's mechanism of action
Pregnancy Registry
encourage patients to enroll in North American Antiepileptic Drug Pregnancy Registry at 1-888-233-2334 or www.aedpregnancyregistry.org
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no known risk of infant harm, though possible risk of infant sedation based on limited human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for lacosamide: liver; CYP450: 2C9, 2C19, 3A4 substrate
Excretion: for lacosamide: urine 95% (40% unchanged), feces <0.5%; Half-life: 13h (adults), 7.2-14.8h (peds)
Subclass: Neuropathy/Neuralgia ; Seizure Disorders
Mechanism of Action
for lacosamide: exact mechanism of action unknown; enhances slow inactivation of voltage-gated Na channels, stabilizing neuronal membranes, inhibiting repetitive firing
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: UCB Pharma, Inc.
DEA/FDA: Schedule V
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral solution:
- 10 mg/mL (600 mL): $1,192.00
oral tablet:
- 50 mg (60 ea): $619.00
- 100 mg (60 ea): $962.00
- 150 mg (60 ea): $1,018.00
- 200 mg (60 ea): $1,019.00
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