Product Description

Lacosamide Tablets 100 mg is a functional amino acid derivative antiepileptic drug (AED) for the management of epilepsy. It is indicated as adjunctive therapy for partial-onset (focal) seizures in patients ≥4 years and adults, and as monotherapy or adjunctive for primary generalized tonic-clonic seizures in patients ≥4 years. By modulating sodium channels, it stabilizes neuronal hyperexcitability to reduce seizure frequency without broad GABA/glutamate effects. Prescription-only; not for absence or myoclonic seizures. Evidence from trials (e.g., PREVAIL) shows 50% seizure reduction in ~40% of patients.

Use

• Adjunctive or monotherapy for partial-onset (focal) seizures with or without secondary generalization in adults and children ≥4 years

• Adjunctive therapy for primary generalized tonic-clonic seizures in patients ≥4 years with idiopathic generalized epilepsy

• Supportive management in refractory epilepsy when other AEDs are insufficient

• Not indicated for Lennox-Gastaut syndrome, status epilepticus as initial therapy, or non-epileptic conditions (e.g., psychiatric disorders)

How it works

Lacosamide selectively binds to and enhances the slow inactivation of voltage-gated sodium (NaV) channels in neuronal membranes:

• This prolongs the refractory period of hyperexcitable neurons, reducing pathological high-frequency firing without affecting normal synaptic transmission.

• It stabilizes membrane potential, normalizes excessive electrical activity, and decreases seizure propagation in focal or generalized epileptiform discharges.

• Additional effects include weak modulation of CRMP-2 (collapsin response mediator protein-2), potentially aiding neuroprotection. Onset: Steady-state in 3 days; full efficacy in 1–2 weeks with titration. Minimal cognitive impact compared to older AEDs.

Benefits

• Effective seizure control: Reduces focal seizure frequency by 40–50% in adjunctive trials (e.g., SP667); monotherapy conversion shows non-inferiority to levetiracetam in adults.

• Broad applicability: Suitable for pediatric (≥4 years) and adult epilepsy, including refractory cases; IV formulation available for hospital bridging.

• Improved quality of life: Fewer seizures correlate with better daily function, sleep, and reduced injury risk; lower sedation than benzodiazepines.

• Favorable profile: Minimal drug interactions (hepatic CYP-independent); tolerable in long-term use (up to 7 years in extensions), with pediatric data supporting growth/normal development.

How to use

Take the tablet exactly as prescribed by your doctor. Take with or without food. Stopping this medication abruptly can increase the frequency of seizures. If you need to stop, your doctor will advise you on a gradual dose reduction.

Side Effects

Common side effects (dose-related; often transient during titration):

• Central nervous system: Dizziness (25–31%), headache (11%), tremor, ataxia, memory impairment, balance issues

• Gastrointestinal: Nausea (7–11%), vomiting, diarrhea

• Ophthalmic: Blurred/double vision (nystagmus, 10–16%)

• General: Fatigue (11%), somnolence

Less common/rare but serious side effects (seek immediate medical attention):

• Cardiac: PR interval prolongation (AV block, bradycardia—monitor ECG), atrial fibrillation/flutter

• Dermatologic: Itching, rash (Stevens-Johnson syndrome rare)

• Psychiatric: Depression, suicidal ideation (AED class warning)

• Other: Hypersensitivity (multi-organ failure), weight loss; infusion-site reactions if IV used

Report new/worsening symptoms; side effects decrease post-titration.

Safety Advice

• Contraindicated in: Hypersensitivity to lacosamide or derivatives; severe hepatic impairment (Child-Pugh C).

• Use caution in: Cardiac conduction disorders (e.g., 2nd/3rd-degree AV block—baseline ECG, monitor PR interval), renal impairment (adjust dose, hemodialysis removes 30%), elderly (increased dizziness/falls), or depression/suicidality history. Not for <4 years (safety unestablished).

• Pregnancy/breastfeeding: Category C—potential teratogenicity (neural tube defects); use if benefits outweigh (AED registry recommended). Excreted in milk (monitor infant for sedation/seizures); prefer alternatives if possible.

• Monitoring: Baseline ECG (PR <200 ms), CBC/LFTs/renal function; seizure diary; suicidality screening. Therapeutic levels: 10–20 mcg/mL (not routine).

• Interactions: Minimal (non-CYP); potentiates CNS depressants (e.g., alcohol—increased dizziness; avoid/limit alcohol); carbamazepine (decreases levels 15%). Inform doctor of all medications/supplements (e.g., St. John's wort).

• Lifestyle: Avoid driving/operating machinery until seizure-free and side effects resolved (e.g., 6 months seizure-free per guidelines). Consistent sleep/schedule; do not taper without guidance.

Storage Conditions

Store at a temperature below 86°F (30 °C). Protect from light and moisture.

FAQs

What is the dosage for Lacosamide 100mg?

The dosage is determined by your doctor based on your specific condition and medical history. The recommended dosage for adults is typically 100 mg twice daily, but this can vary. Your doctor may start you on a low dose and gradually increase it over time to find the most effective dose with the fewest side effects. 

When should I take lacosamide?

The tablets are usually taken twice a day, about 12 hours apart, with or without food. Taking the medication at the same time each day can help maintain consistent levels in your body, which is important for seizure control. 

What should I do if I miss a dose?

If you miss a dose, take it as soon as you remember. However, if it has been more than 6 hours since the missed dose, you should skip it and take your next dose at the regularly scheduled time. Do not take a double dose to make up for the missed one. 

Can I drink alcohol while taking lacosamide?

It is not recommended to drink alcohol while taking lacosamide, as it can increase side effects such as dizziness and drowsiness. Alcohol can also lower the seizure threshold in some people. 

Is lacosamide habit-forming?

No, lacosamide is not considered a habit-forming medicine. 

Is it safe for pregnant or breastfeeding women?

Lacosamide is generally not recommended for use during pregnancy or breastfeeding, as its safety has not been established in these populations. If you are pregnant, planning to become pregnant, or breastfeeding, you should discuss the risks and benefits with your doctor. 

How long does it take for lacosamide to work?

It may take a few weeks or longer before you feel the full benefit of the medication. It is important to continue taking it as prescribed even if you feel well.