Lacosamide

About Lacosamide

Exactly how lacosamide works is not fully known; in laboratory studies it enhances the slow inactivation of sodium channels, steadying overexcited nerve cells. Vimpat and its generics are labeled for partial-onset seizures from one month of age, alone or with other medicines, and as add-on treatment for primary generalized tonic-clonic seizures from age 4; Motpoly XR, a once-daily capsule, covers both in adults and in children weighing at least 50 kg. Adults usually start at 100 mg twice a day alone or 50 mg twice a day as add-on, rising weekly by 50 mg twice a day to at most 200 mg twice a day, and children are dosed by weight; a single 200 mg loading dose may be given under medical supervision. The injection is used when taking it by mouth is temporarily not possible.

There is no boxed warning. Dizziness and loss of coordination have their own warning, and double vision, headache, dizziness, nausea and sleepiness are the most common side effects in adults; people should not drive or use machinery until they know how it affects them. It lengthens the PR interval on the ECG and can cause heart block, a slow heartbeat, ventricular tachyarrhythmia and, rarely, cardiac arrest, mostly in people with conduction problems or on other drugs that affect conduction, for whom an ECG is advised before starting and once the dose is reached. Atrial fibrillation or flutter is more likely with heart disease or diabetic nerve damage, and in studies of diabetic nerve pain, fainting occurred mostly above 400 mg a day. Other warnings cover suicidal thoughts, DRESS (a drug reaction with rash, fever and organ involvement), and seizures on stopping, so it is withdrawn over at least a week.

Lacosamide is a Schedule V controlled substance: refills are those the prescriber authorizes, where state law allows, and refill information can be moved between pharmacies only once unless they share a real-time online database. Severe kidney impairment, kidney failure and mild to moderate liver impairment call for a lower maximum dose, it is not recommended in severe liver impairment, and strong CYP3A4 and CYP2C9 inhibitors can raise its levels in people with either. Vimpat oral solution contains aspartame, a source of phenylalanine, which matters in phenylketonuria. Generic tablets, solution and injection were approved from 2022, and the label encourages pregnant patients to join the North American Antiepileptic Drug Pregnancy Registry.

Taking Lacosamide

How to take it

Tablets and oral solution are usually taken twice a day and Motpoly XR once a day, with or without food. Swallow tablets whole with liquid, without dividing them, and swallow Motpoly XR capsules whole with liquid without opening, chewing or crushing them. Measure the liquid with a marked oral syringe or dose-measuring spoon, never a household spoon.

If you miss a dose

Take the missed dose as soon as you remember, unless it is almost time for the next one; then skip it. Never take a double dose, and do not stop it without the prescriber, since stopping suddenly can bring on more seizures.

Storage

At room temperature, away from heat and moisture, out of reach of children. Do not freeze the oral solution, and throw away any left six months after first opening the bottle.

Interactions to know about

Beta blockers, calcium channel blockers, other sodium channel blockers, potassium channel blockers and other drugs that lengthen the PR interval add to its effect on heart rhythm. Strong CYP3A4 and CYP2C9 inhibitors can raise its levels in people with kidney or liver impairment. Report a slow, fast, pounding or irregular heartbeat, or fainting, at once.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Lacosamide differs from pharmacy to pharmacy

Generic tablets come from many makers, so a quote for them is mostly the pharmacy’s fee and markup, unless the prescription names Vimpat and blocks substitution. The oral solution has generics too. Motpoly XR has no generic and is priced as a brand, and its once-daily capsules cannot be swapped for twice-daily tablets at the counter.

A pharmacy that does not stock your strength may need to order it, and because refill information for a controlled substance can be transferred only once, it is worth choosing the pharmacy before the first fill.

Ways to pay less for Lacosamide without insurance

• Ask for generic tablets, and make sure the prescription allows substitution rather than naming Vimpat only.
• Once your dose is stable, ask the prescriber for a ninety-day supply with the refills you will need.
• If Motpoly XR is prescribed, ask the maker whether a savings or patient assistance program applies to someone paying cash, and ask the prescriber whether twice-daily generic tablets would suit you.
• Compare more than one pharmacy, and fill at the one you plan to keep, since refill information can be transferred only once.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Lacosamide

1. 1.Do I need an ECG before starting or after my dose goes up?
2. 2.Do any of my heart or blood pressure medicines add to its effect on heart rhythm?
3. 3.How many refills does my prescription allow?
4. 4.How do I measure the liquid, and when should I throw out an opened bottle?

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