Lacosamide (
Vimpat(®)) is a functionalized
amino acid available orally (as a syrup or
tablet) and as an
intravenous infusion. It is believed to exert its
antiepileptic effect by selectively enhancing the slow inactivation of
voltage-gated sodium channels.
Lacosamide is approved in several countries worldwide as an adjunctive
therapy for the treatment of partial-onset
seizures; however, prescribing regulations differ between countries. This article reviews the use of
lacosamide as indicated in adults and adolescents (aged 16-18 years) in the EU, where it is approved in this patient population as an adjunctive
therapy to other AEDs in the treatment of partial-onset
seizures, with or without secondary generalization. In three randomized, double-blind, placebo-controlled, multicentre studies in adults and adolescents (aged 16-18 years) with partial-onset
seizures, adjunctive
therapy with oral
lacosamide (administered for an initial titration period followed by 12 weeks' maintenance
therapy) generally reduced the frequency of
seizures to a significantly greater extent than placebo, with
antiepileptic efficacy sustained following longer-term treatment (up to 8 years) in this patient population. Oral and intravenous
lacosamide were generally well tolerated in clinical studies, with the majority of adverse events being mild or moderate in severity. Very common adverse reactions following adjunctive
therapy with oral
lacosamide included
diplopia,
dizziness,
headache and
nausea; the tolerability profile of intravenous
lacosamide appeared consistent with that of oral
lacosamide, although
intravenous administration was associated with local adverse events, such as injection site discomfort or
pain, irritation and
erythema. Thus, oral and intravenous
lacosamide as an adjunctive
therapy to other AEDs provides a useful option in the treatment of patients with partial-onset
seizures.