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Lacosamide Dosage

Medically reviewed on November 13, 2017.

Applies to the following strengths: 200 mg/20 mL; 50 mg; 100 mg; 150 mg; 200 mg; 10 mg/mL

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Epilepsy

MONOTHERAPY:
-Initial dose: 100 mg orally or IV 2 times a day (200 mg/day) for 1 week; alternatively, 200 mg orally or IV may be given as a single loading dose, followed 12 hours later by 100 mg orally or IV 2 times a day for 1 week
-Titration: Increase by 50 mg 2 times a day (100 mg/day) every week
-Maintenance dose: 150 to 200 mg orally or IV 2 times a day (300 to 400 mg/day)

ADJUNCTIVE THERAPY:
-Initial dose: 50 mg orally or IV 2 times a day (100 mg/day) for 1 week; alternatively, 200 mg orally or IV may be given as a single loading dose, followed 12 hours later by 100 mg orally or IV 2 times a day for 1 week
-Titration: Increase by 50 mg 2 times a day (100 mg/day) every week
-Maintenance dose: 100 to 200 mg orally or IV 2 times a day (200 to 400 mg/day)

Comments:
-Therapy can be initiated with either oral or IV administration.
-The loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions.
-The oral formulation may be taken with or without food.
-The IV formulation is intended as an alternative when oral administration is temporarily not feasible.
-The IV formulation can be administered in the same dosing regimens used for oral dosing, including the loading dose.
-The IV formulation should be infused over a period of 15 to 60 minutes; IV infusion over 30 to 60 minutes is preferable, and should be used when a 15-minute administration is not required.
-In adult patients, a dose higher than 200 mg 2 times a day (400 mg/day) is not more effective and is associated with a substantially higher rate of adverse reactions.
-The dose should be increased based on clinical response and tolerability, no more frequently than once per week.

Use: As monotherapy or adjunctive therapy for partial-onset seizures in patients 17 years and older

Usual Adult Dose for Seizures

MONOTHERAPY:
-Initial dose: 100 mg orally or IV 2 times a day (200 mg/day) for 1 week; alternatively, 200 mg orally or IV may be given as a single loading dose, followed 12 hours later by 100 mg orally or IV 2 times a day for 1 week
-Titration: Increase by 50 mg 2 times a day (100 mg/day) every week
-Maintenance dose: 150 to 200 mg orally or IV 2 times a day (300 to 400 mg/day)

ADJUNCTIVE THERAPY:
-Initial dose: 50 mg orally or IV 2 times a day (100 mg/day) for 1 week; alternatively, 200 mg orally or IV may be given as a single loading dose, followed 12 hours later by 100 mg orally or IV 2 times a day for 1 week
-Titration: Increase by 50 mg 2 times a day (100 mg/day) every week
-Maintenance dose: 100 to 200 mg orally or IV 2 times a day (200 to 400 mg/day)

Comments:
-Therapy can be initiated with either oral or IV administration.
-The loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions.
-The oral formulation may be taken with or without food.
-The IV formulation is intended as an alternative when oral administration is temporarily not feasible.
-The IV formulation can be administered in the same dosing regimens used for oral dosing, including the loading dose.
-The IV formulation should be infused over a period of 15 to 60 minutes; IV infusion over 30 to 60 minutes is preferable, and should be used when a 15-minute administration is not required.
-In adult patients, a dose higher than 200 mg 2 times a day (400 mg/day) is not more effective and is associated with a substantially higher rate of adverse reactions.
-The dose should be increased based on clinical response and tolerability, no more frequently than once per week.

Use: As monotherapy or adjunctive therapy for partial-onset seizures in patients 17 years and older

Usual Pediatric Dose for Epilepsy

MONOTHERAPY:
4 to less than 17 years:
50 kg or greater:
-Initial dose: 50 mg orally 2 times a day (100 mg/day) for 1 week
-Titration: Increase by 50 mg orally 2 times a day (100 mg/day) every week
-Maintenance dose: 150 to 200 mg orally 2 times a day (300 to 400 mg/day)
30 to less than 50 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 2 to 4 mg/kg orally 2 times a day (4 to 8 mg/kg/day)
11 to less than 30 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 3 to 6 mg/kg orally 2 times a day (6 to 12 mg/kg/day)

ADJUNCTIVE THERAPY:
4 to less than 17 years:
50 kg or greater:
-Initial dose: 50 mg orally 2 times a day (100 mg/day) for 1 week
-Titration: Increase by 50 mg orally 2 times a day (100 mg/day) every week
-Maintenance dose: 100 to 200 mg orally 2 times a day (200 to 400 mg/day)
30 to less than 50 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 2 to 4 mg/kg orally 2 times a day (4 to 8 mg/kg/day)
11 to less than 30 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 3 to 6 mg/kg orally 2 times a day (6 to 12 mg/kg/day)

17 years and older: See Adult Dosing

Comments:
-Therapy can be initiated with either oral or IV administration.
-The loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions.
-The oral formulation may be taken with or without food.
-The IV formulation is intended as an alternative when oral administration is temporarily not feasible.
-The IV formulation can be administered in the same dosing regimens used for oral dosing, including the loading dose.
-The IV formulation should be infused over a period of 15 to 60 minutes; IV infusion over 30 to 60 minutes is preferable, and should be used when a 15-minute administration is not required.
-In adult patients, a dose higher than 200 mg 2 times a day (400 mg/day) is not more effective and is associated with a substantially higher rate of adverse reactions.
-The dose should be increased based on clinical response and tolerability, no more frequently than once per week.

Use: As monotherapy or adjunctive therapy for partial-onset seizures in patients 4 years and older

Usual Pediatric Dose for Seizures

MONOTHERAPY:
4 to less than 17 years:
50 kg or greater:
-Initial dose: 50 mg orally 2 times a day (100 mg/day) for 1 week
-Titration: Increase by 50 mg orally 2 times a day (100 mg/day) every week
-Maintenance dose: 150 to 200 mg orally 2 times a day (300 to 400 mg/day)
30 to less than 50 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 2 to 4 mg/kg orally 2 times a day (4 to 8 mg/kg/day)
11 to less than 30 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 3 to 6 mg/kg orally 2 times a day (6 to 12 mg/kg/day)

ADJUNCTIVE THERAPY:
4 to less than 17 years:
50 kg or greater:
-Initial dose: 50 mg orally 2 times a day (100 mg/day) for 1 week
-Titration: Increase by 50 mg orally 2 times a day (100 mg/day) every week
-Maintenance dose: 100 to 200 mg orally 2 times a day (200 to 400 mg/day)
30 to less than 50 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 2 to 4 mg/kg orally 2 times a day (4 to 8 mg/kg/day)
11 to less than 30 kg:
-Initial dose: 1 mg/kg orally 2 times a day (2 mg/kg/day) for 1 week
-Titration: Increase by 1 mg/kg orally 2 times a day (2 mg/kg/day) every week
-Maintenance dose: 3 to 6 mg/kg orally 2 times a day (6 to 12 mg/kg/day)

17 years and older: See Adult Dosing

Comments:
-Therapy can be initiated with either oral or IV administration.
-The loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions.
-The oral formulation may be taken with or without food.
-The IV formulation is intended as an alternative when oral administration is temporarily not feasible.
-The IV formulation can be administered in the same dosing regimens used for oral dosing, including the loading dose.
-The IV formulation should be infused over a period of 15 to 60 minutes; IV infusion over 30 to 60 minutes is preferable, and should be used when a 15-minute administration is not required.
-In adult patients, a dose higher than 200 mg 2 times a day (400 mg/day) is not more effective and is associated with a substantially higher rate of adverse reactions.
-The dose should be increased based on clinical response and tolerability, no more frequently than once per week.

Use: As monotherapy or adjunctive therapy for partial-onset seizures in patients 4 years and older

Renal Dose Adjustments

-Mild to moderate renal dysfunction (CrCl greater than 30 mL/min): No adjustment recommended
-Severe renal dysfunction (CrCl 30 mL/min or less) and end-stage renal disease: A reduction of 25% of the maximum dose is recommended.
-In all renally impaired patients, the dose titration should be performed with caution.
-Patients with renal impairment who are taking strong inhibitors of CYP450 3A4 and CYP450 2C9 may have a significant increase in exposure to this drug; therefore, dose reduction may be necessary in these patients.

Liver Dose Adjustments

-Mild to moderate hepatic impairment: A maximum dose of 300 mg/day is recommended.
-Severe hepatic impairment: Not recommended.
-Dose titration should be performed with caution in patients with hepatic impairment.

Dose Adjustments

-Safety and efficacy of the tablet and oral solution formulations have not been established in patients younger than 4 years.
-Safety and efficacy of the IV formulation have not been established in patients younger than 17 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule V

Precautions

Safety and efficacy have not been established in patients younger than 17 years.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is effectively removed from plasma by hemodialysis. Following a 4-hour hemodialysis treatment, the AUC is reduced by approximately 50%; therefore, dosage supplementation of up to 50% following hemodialysis should be considered.

Other Comments

Administration advice:
-The oral formulation may be taken with or without food.
-When using the oral solution, it is recommended that a calibrated measuring device be obtained and used. A household teaspoon or tablespoon is not an adequate measuring device.
-The IV formulation should be infused over a period of 30 to 60 minutes.
-The IV formulation can be administered in the same dosing regimens described for oral dosing,

Storage requirements:
-Consult the manufacturer product information.

Reconstitution/preparation techniques:
-The IV formulation can be administered without further dilution or may be mixed with diluents.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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