Lacosamide Disease Interactions

Antiepileptic drugs can increase depression and suicidal thoughts or behaviors in patients receiving these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts and unusual changes in mood or behavior. Caregivers and family should be alert for the emergence or worsening of symptoms. Behaviors of concern should be reported immediately to the healthcare providers.

Dose dependent prolongation in PR interval has been observed with the use of lacosamide. This drug should be used with caution in patients with known conduction abnormalities (AV block, sick sinus syndrome) in patients with sodium channelopathies (e.g., Brugada syndrome), with severe cardiac disease (myocardial ischemia, heart failure, structural disease), or in treatment with other drugs that also prolong PR interval. An ECG is recommended before beginning treatment, and after dose titration to a steady maintenance dose.

Patients with mild to moderate hepatic impairment should be observed closely during lacosamide dose titration. A maximum dose of 300 mg/day is recommended for these patients. Lacosamide has not been evaluated in patients with severe hepatic impairment, so its use is not recommended in this group of patients.

A maximum dose of 300 mg/day of lacosamide is recommended for patients with severe renal impairment (CrCl <30 mL/min) and in patients with end stage renal disease. Lacosamide is effectively removed from plasma by hemodialysis and a dose supplementation of 50% should be considered following this procedure. Dose titration should be done with caution in all renally impaired patients.