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Lacosamide Dosage

Medically reviewed on April 10, 2018.

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

Converting from a Single Antiepileptic (AED) to Monotherapy:
-Withdrawal of concomitant AED should not occur until the therapeutic dose of this drug is achieved and maintained for at least 3 days, then a gradual withdrawal of concomitant AED over at least 6 weeks is recommended.

Concomitant use with Strong CYP450 3A4 or CYP450 2C9 Inhibitors:
-Dose reduction may be necessary in patients with renal impairment or hepatic impairment

Precautions

-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

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:
-Take orally with or without food twice a day; morning and evening

Oral solution:
-Use provided calibrated measuring device; do not use a household teaspoon or tablespoon as it is not an adequate measuring device
-May be administered using a nasogastric tube or gastrostomy tube
-Discard unused oral solution 7 weeks after first opening bottle
-Note: Oral solution contains aspartame, a source of phenylalanine (200 mg dose contains 0.32 mg of phenylalanine)

IV formulation
-Administer as IV infusion over 15 to 60 minutes twice a day, preferably over at least 30 minutes
-Solution for infusion may be administered without further dilution or may be diluted with normal saline, D5W, or lactated ringers
-Diluted solution should not be stored for more than 4 hours at room temperature

Storage requirements:
-IV: Store at 20C to 25C (68F to 77F); Do not freeze
-Oral solution: Store at 20C to 25C (68F to 77F); do not freeze; discard unused oral solution 7 weeks after first opening bottle

Reconstitution/preparation techniques:
-IV: May be diluted with normal saline, D5W, or lactated ringers

General:
-IV infusion may cause bradycardia or AV blocks; administer over at least 30 minutes whenever possible.
-Dose-dependent prolongations in PR interval have been observed in clinical studies and in healthy volunteers. Use cautiously in patients with known cardiac conduction problems (e.g., marked first-degree AV block, second-degree or higher AV block and sick sinus syndrome without pacemaker), sodium channelopathies (e.g., Brugada Syndrome) on concomitant medications that prolong PR interval, or with severe cardiac disease such as myocardial ischemia or heart failure, or structural heart disease.
-Patients with phenylketonuria (PKU) should be aware that the oral solution contains aspartame, a source of phenylalanine.

Monitoring:
-Monitor for unusual changes in mood or behavior, especially the emergence of suicidal thoughts or behaviors
-Monitor for hepatotoxicity
-Obtain ECG before therapy after titration to steady-state in patients at risk for PR interval prolongation (see section above for at-risk patients)

Patient Advice:
-Patients should be aware of the symptoms of second-degree or higher AV block (e.g. slow or irregular pulse, feeling of lightheaded and fainting) and of the symptoms of atrial fibrillation and flutter (e.g. palpitations, rapid or irregular pulse, shortness of breath); patients should be instructed to seek medical advice should any of these symptoms occur.
-Patients should be aware that this drug may increase the risk of suicidal thoughts and behaviors; unusual changes in mood or behaviors should be reported immediately to their healthcare provider.
-Patients should be aware that this drug may cause dizziness, double vision, abnormal coordination and balance, and somnolence; patients should be counseled on risks of driving and engaging in other hazardous activities.
-Patients should be instructed to speak with their healthcare provider if they are pregnant, intending to become pregnant or breastfeeding.
-Patients should be instructed to promptly report signs or symptoms of hepatotoxicity or early manifestation of hypersensitivity (e.g., fever, lymphadenopathy).

Further information

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

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