Vimpat (lacosamide)

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There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

Moderate Interaction: Assess the risk to the patient and take action as needed.

Lacosamide/Beta-Blockers; Diltiazem; Verapamil

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Lacosamide may enhance the slow inactivation of voltage-gated sodium channels and may cause dose-dependent bradycardia, prolongation of the PR interval, atrioventricular (AV) block, or ventricular tachyarrhythmia.(1)

CLINICAL EFFECTS: Concurrent use of lacosamide and agents that affect cardiac conduction (beta-blockers, non-dihydropyridine calcium channel blockers) may increase the risk of bradycardia, prolongation of the PR interval, atrioventricular (AV) block, or ventricular tachyarrhythmia.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Lacosamide should be used with caution in patients on concomitant medications that affect cardiac conduction, including beta-blockers and non-dihydropyridine calcium channel blockers.(1) If concurrent use is needed, obtain an ECG before lacosamide therapy and after lacosamide dose is titrated to steady-state.(1) Patients should be monitored closely when lacosamide is given intravenously.(1)

DISCUSSION: In a clinical trial in patients with partial-onset seizures, asymptomatic first-degree atrioventricular (AV) block occurred in 4/944 (0.4%) of patient who received lacosamide compared to 0/364 (0%) with placebo.(1) In a clinical trial in patients with diabetic neuropathy, asymptomatic first-degree AV block occurred in 5/1023 (0.5%) of patients who received lacosamide compared to 0/291 (0%) with placebo.(1) Second-degree and complete AV block have been reported in patients with seizures.(1) One case of profound bradycardia was observed in a patient during a 15-minute infusion of 150 mg of lacosamide.(1) Two postmarketing reports of third-degree AV block in patients with significant cardiac history and also receiving metoprolol and amlodipine during infusion of lacosamide injection at doses higher than recommended have been reported.(1) A case report of an 88 year old female taking bisoprolol documented complete AV block after initiation of lacosamide. The patient required pacemaker implementation.(2)

Lacosamide/Sodium Channel Blocker; Potassium Channel Blocker

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Lacosamide may enhance the slow inactivation of voltage-gated sodium channels and may cause dose-dependent bradycardia, prolongation of the PR interval, atrioventricular (AV) block, or ventricular tachyarrhythmia.(1)

CLINICAL EFFECTS: Concurrent use of lacosamide and agents that affect cardiac conduction (sodium channel blockers and potassium channel blockers) may increase the risk of bradycardia, prolongation of the PR interval, atrioventricular (AV) block, or ventricular tachyarrhythmia.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Lacosamide should be used with caution in patients on concomitant medications that affect cardiac conduction, including sodium channel blockers and potassium channel blockers.(1) If concurrent use is needed, obtain an ECG before lacosamide therapy and after lacosamide dose is titrated to steady-state.(1) Patients should be monitored closely when lacosamide is given intravenously.(1)

DISCUSSION: In a clinical trial in patients with partial-onset seizures, asymptomatic first-degree atrioventricular (AV) block occurred in 4/944 (0.4%) of patient who received lacosamide compared to 0/364 (0%) with placebo.(1) In a clinical trial in patients with diabetic neuropathy, asymptomatic first-degree AV block occurred in 5/1023 (0.5%) of patients who received lacosamide compared to 0/291 (0%) with placebo.(1) Second-degree and complete AV block have been reported in patients with seizures.(1) One case of profound bradycardia was observed in a patient during a 15-minute infusion of 150 mg of lacosamide.(1) A case report of a 49 year old male with refractory complex partial and generalized seizures described the development of ventricular tachycardia four months after addition of lacosamide 400 mg/day to the existing regimen of carbamazepine, lamotrigine, clonazepam, and valproate. The patient's ECG showed first-degree AV block, posterior left fascicular block, and severe widening of the QRS complex, all of which resolved upon discontinuation of lacosamide.(2)

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There are no contraindication contraindications for this drug.

• Brugada syndrome
• Child-pugh class A hepatic impairment
• Child-pugh class B hepatic impairment
• Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
• Chronic kidney disease stage 5 (failure) GFr<15 ml/min
• Complete atrioventricular block
• Disease of liver
• Pregnancy
• Second degree atrioventricular heart block
• Suicidal ideation

• Atrial fibrillation
• Atrial flutter
• Chronic heart failure
• Coronary artery disease
• First degree atrioventricular heart block
• Kidney disease with likely reduction in glomerular filtration rate (GFr)
• Myocardial ischemia
• Orthostatic hypotension
• Sick sinus syndrome
• Structural disorder of heart

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Rare or Very Rare

• Accidental fall
• Agranulocytosis
• Angioedema
• Atrial fibrillation
• Atrial flutter
• Atrioventricular block
• Autoimmune hepatitis
• Bradycardia
• DRESS syndrome
• Drug-induced psychosis
• Dyskinesia
• Eosinophilia
• Myocarditis
• Nephritis
• Neutropenic disorder
• Paradoxical convulsion
• Stevens-johnson syndrome
• Suicidal
• Suicidal ideation
• Syncope
• Toxic epidermal necrolysis
• Ventricular tachycardia
• Worsening of seizure

More Frequent

• Blurred vision
• Diplopia
• Dizziness
• Headache disorder
• Nausea
• Vomiting

Less Frequent

• Ataxia
• Diarrhea
• Drowsy
• Fatigue
• Gait abnormality
• General weakness
• Injection site sequelae
• Memory impairment
• Nystagmus
• Oral hypoesthesia
• Pruritus of skin
• Tremor
• Vertigo

Rare or Very Rare

• Abnormal hepatic function tests
• Acute cognitive impairment
• Aggressive behavior
• Agitation
• Anemia
• Constipation
• Depression
• Disturbance of attention
• Dysarthria
• Dyspepsia
• Feeling of alcohol intoxication
• Fever
• Hallucinations
• Hypoesthesia
• Insomnia
• Irritability
• Mood changes
• Muscle spasm
• Palpitations
• Paresthesia
• Prolonged PR interval
• Skin rash
• Tinnitus
• Urticaria
• Xerostomia

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