- Adjunctive therapy for medically refractory partial-onset epilepsy or refractory status epilepticus when all other anti-epileptic drugs are ineffective or not appropriate
- 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.)
| SC | NO |
| IM | NO |
| 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
Pediatric:
-
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 recommendedAdults:
-
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
- 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