Parenteral Manual


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Alternate Name(s): 
Original Date: 
February 2018
  • Adjunctive therapy for medically refractory partial-onset epilepsy or refractory status epilepticus when all other anti-epileptic drugs are ineffective or not appropriate



Reconstitution and Stability: 
  • Available as 10 mg/mL solution in 20 mL single-use vials - discard unused portion of vial
  • Clear colorless solution - do not use if shows haziness, particulate matter, or discoloration
  • Store vials at room temperature - do not freeze
  • Stable 24 hours at room temperature when mixed with D5W, Lactated Ringer's, or 0.9% NaCl  in glass or polyvinyl chloride (PVC) bags - discard any unused portion

- Solutions Compatible:  D5W, Lactated Ringer's, 0.9% NaCL

- Additives/Above Cassette Compatible:  No Information

- Y-site Compatible:  No Information

- Incompatible:  No Information


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct NO
IV Intermittent Infusion YES
Usual dilution: undiluted or further diluted with compatible diluent
Infusion time: 30 to 60 minutes
IV Continuous Infusion NO



(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • When switching from oral to IV formulations, the total daily dose and frequency should be the same; IV therapy should only be used temporarily. Clinical study experience of IV lacosamide is limited to 5 days of consecutive treatment


  • Status epilepticus, refractory
          - 2 – 10 mg/kg/dose IV

  • Partial-onset seizure (1 – 16 years old)    
         - Initial: 0.5 mg/kg/dose IV BID
         - May be titrated by 1 mg/kg/day on a weekly basis to 2.5 – 5 mg/kg/dose TID

  • MAXIMUM DOSE: 400 mg/day IV

  •  Dose adjustment for renal impairment
          - mild to moderate: No dose adjustment
          - CrCl ≤ 30 mL/min: Limit 300 mg/day

  •  Dose adjustment for hepatic impairment:
         -  mild to moderate: Limit 300 mg/day
         -  severe: Not recommended


  • Status epilepticus, refractory
         - 200 - 400 mg followed by daily maintenance dose of 200 - 600 mg daily in 2 divided doses

  • Partial onset seizure
      -  Monotherapy:

           - Initial: 100 mg BID or loading dose of 200 mg followed approximately 12 hours later by 100 mg BID for 1 week

           - May increase at weekly intervals by 50 mg BID

            - Maintenance: 150 – 200 mg BID

      -  Adjunctive:

           - Initial: 50 mg BID or loading dose of 200 mg followed approximately 12 hours later by 100 mg BID for 1 week

           - May increase at weekly intervals by 50 mg BID

           - Maintenance: 100 – 200 mg BID

Potential hazards of parenteral administration: 
  • CNS (abnormal gait, dizziness, fatigue, ataxia, headache, drowsiness, memory impairment, depression)
  • Nausea, vomiting, diarrhea
  • Tremor, nystagmus, (chorea on day 5 reported in one patient)
  • Blurred vision, double vision, (oculogyric crisis on day 4 reported in one patient)
  • Syncope (adults; dose-related: >400 mg/day)
  • Bradycardia and AV Block (have both occurred during infusions)
  • Contraindicated in patients with history of, or presence of, second to/or third degree atrioventricular (AV) block
  • Monitor HR, BP during IV administration
  • Monitor hepatic and renal function; suicidality (eg, suicidal thoughts, depression, behavioral changes)
  • Baseline ECG recommended for patients on long-term treatment
  • ECG tracing prior to start of therapy and when at steady state for patients with conduction problems, concomitant medications known to prolong PR interval or severe cardiac disease

 - Strzelczyk, A., Zöllner, J. P., Willems, L. M., Jost, J., Paule, E., Schubert-Bast, S., Rosenow, F. and Bauer, S. (2017), Lacosamide in status epilepticus: Systematic review of current evidence. Epilepsia, 58: 933–950. doi:10.1111/epi.13716

 - SickKids Drug Handbook and Formulary, 2017

 - Lacosamide Product Monograph, 2013 (UCB Canada Inc.)

 - Lexicomp Drug Reference 22nd Edition

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