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Lacosamide Dosage

Applies to the following strength(s): 200 mg/20 mL ; 50 mg ; 100 mg ; 150 mg ; 200 mg ; 10 mg/mL

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Seizures

MONOTHERAPY:
-Initial dose: 100 mg twice a day (200 mg per day)
-Titration: Increase the dose by 50 mg twice a day (100 mg per day) every 7 days
-Maintenance dose: 150 to 200 mg twice a day (300 to 400 mg per day)
-Alternate dosing: Initiate therapy with a single loading dose of 200 mg, followed 12 hours later by 100 mg twice a day for 7 days; based on individual response and tolerability, the dose can be increased by 50 mg twice a day (100 mg per day) every 7 days, as needed, up to a maintenance dose of 150 to 200 mg twice a day (the loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions)

ADJUNCTIVE THERAPY:
-Initial dose: 50 mg twice a day (100 mg per day)
-Titration: Increase the dose by 50 mg twice a day (100 mg per day) every 7 days
-Maintenance dose: 100 to 200 mg twice a day (200 to 400 mg per day)
-Alternate dosing: Initiate therapy with a single loading dose of 200 mg, followed 12 hours later by 100 mg twice a day for 7 days; based on individual response and tolerability, the dose can be increased by 50 mg twice a day, as needed, up to the maximum maintenance dose of 200 mg twice a day (the loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions)

Comments:
-Therapy can be initiated with either oral or IV administration.
-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.

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

Usual Pediatric Dose for Seizures

Less than 17 years of age: Not recommended
17 years of age and older: See Adult Dosing

Renal Dose Adjustments

-Mild to moderate renal dysfunction (CrCl greater than 30 mL/min): No adjustment recommended
-Severe renal dysfunction (CrCl less than or equal to 30 mL/min) and end-stage renal disease: A maximum dose of 300 mg/day 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

-Monotherapy: For patients who are already on a single antiepileptic and will convert to this drug as monotherapy, the maintenance dose of 150 to 200 mg twice a day should be maintained for at least 3 days before initiating withdrawal of the concomitant antiepileptic drug and the withdrawal should take place over at least a 6-week period
-In clinical trials, the 600 mg daily dose was not more effective than the 400 mg daily dose, and was associated with a substantially higher rate of adverse reactions.

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.

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