Home Drug Guide Lacosamide

Drug Guide

Generic Name

Lacosamide

Brand Names Vimpat, Motpoly Xr

Classification

Therapeutic: Anticonvulsant

Pharmacological: Voltage-gated sodium channel blocker, analgesic

FDA Approved Indications

  • Partial-onset seizures with or without secondarily generalized seizures

Mechanism of Action

Lacosamide selectively enhances slow inactivation of voltage-gated sodium channels, stabilizing hyperexcitable neuronal membranes and inhibiting repetitive neuronal firing.

Dosage and Administration

Adult: Start with 50 mg twice daily; increase gradually to a target dose of 200-400 mg/day based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Adjust dose based on renal function and tolerability; start at lower end of dosing range.

Renal Impairment: Reduce dose in renal impairment; monitor renal function.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Rapidly absorbed, bioavailability approximately 100%.

Distribution: Widely distributed; volume of distribution ~55 L.

Metabolism: Minimal hepatic metabolism; primarily excreted unchanged in urine.

Excretion: Primarily via urine (~95%).

Half Life: approximately 13 hours.

Contraindications

  • Hypersensitivity to lacosamide or other ingredients.

Precautions

  • Use with caution in patients with cardiac arrhythmias, conduction block, or moderate to severe hepatic impairment.
  • Monitor for suicidal ideation and behavior.
  • Potential for CNS depression; caution with other CNS depressants.

Adverse Reactions - Common

  • Dizziness (Frequent)
  • Headache (Frequent)
  • Nausea (Frequent)
  • Diplopia (Frequent)

Adverse Reactions - Serious

  • Elderly patients: prolongation of PR interval leading to atrioventricular block (rare) (Rare)
  • Suicidal thoughts or behavior (Uncommon)
  • Breathing difficulties (hypersensitivity reactions) (Rare)

Drug-Drug Interactions

  • Other sodium channel blockers, CNS depressants, drugs that prolong PR interval (e.g., AV nodal blocking agents).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Baseline ECG, renal function, mental status, history of cardiac arrhythmias.

Diagnoses:

  • Risk for injury due to dizziness or somnolence.
  • Risk for cardiac conduction abnormalities.

Implementation: Administer as prescribed, monitor for adverse effects, especially cardiac conduction and neuropsychiatric effects.

Evaluation: Assess seizure control, monitor for adverse reactions, adherence.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of dizziness, vision changes, or mood changes.
  • Do not abruptly stop medication.
  • Avoid alcohol and CNS depressants unless directed.

Special Considerations

Black Box Warnings:

  • Potential for available for cardiac conduction disturbances, including PR prolongation and atrioventricular block.

Genetic Factors: Patients with certain variants may have increased risk of cardiac side effects.

Lab Test Interference: May cause false increase in serum lab values (e.g., INR).

Overdose Management

Signs/Symptoms: Dizziness, ataxia, nystagmus, seizures, cardiac conduction delays.

Treatment: Supportive care, activated charcoal if early, cardiac monitoring, ensure airway patency, consider ECG for conduction issues.

Storage and Handling

Storage: Store at room temperature away from moisture, heat, and light.

Stability: Stable through expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.