|Values are valid only on day of printing.|
Monitoring serum concentrations of lacosamide to ensure compliance and appropriate dosing in specific clinical conditions (ie, severe renal impairment, mild-to-moderate hepatic impairment, and end-stage renal disease)
Lacosamide is approved for adjunctive therapy to treat partial-onset seizures in epileptic patients 17 years of age and older. In clinical trials, the most common side effects were dizziness, headache, nausea, and double vision. Lacosamide is completely absorbed after oral administration with negligible first-pass metabolism. Peak plasma concentrations occur 1 to 4 hours after oral dosing, and the elimination half-life is approximately 13 hours. Steady-state plasma concentrations are achieved after 3 days of twice daily repeated administration. About 40% of the administered dose is eliminated by the renal system unchanged and 30% is metabolized by hepatic isoenzymes (CYP2C9, CYP2C19, and CYP3A4) to the O-desmethyl inactive metabolite. The relationship between lacosamide plasma concentrations and its efficacy or adverse effects is not well established. However, central nervous system toxicity has been associated with higher drug concentrations in plasma.
Patients receiving therapeutic doses usually have lacosamide concentrations of 1.0-10.0 mcg/mL.
The serum concentration should be interpreted in the context of the patient's clinical response and may provide useful information in patients showing poor response or adverse effects, particularly when lacosamide is coadministered with other anticonvulsant drugs.
Toxic ranges have not been established.
Abnormalities in liver function tests (alanine aminotransferase) have been observed in controlled trials in adult patients with partial-onset seizures who were taking 1 to 3 concomitant antiepileptic drugs.
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