Lacosamide Dosage

Medically reviewed by Drugs.com. Last updated on Feb 4, 2025.

Usual Adult Dose for Epilepsy

MONOTHERAPY FOR PARTIAL-ONSET SEIZURES:
Initial dose: 100 mg orally twice a day

• Titrate in increments of 100 mg (50 mg twice a day) no more frequently than once a week based on clinical response and tolerability

Maintenance dose: 150 to 200 mg orally twice a day

ADJUNCTIVE THERAPY FOR PARTIAL-ONSET SEIZURES OR GENERALIZED TONIC-CLONIC SEIZURES: :
Initial dose: 50 mg orally twice a day

• Titrate in increments of 100 mg (50 mg twice a day) no more frequently than once a week based on clinical response and tolerability

Maintenance dose: 100 to 200 mg orally twice a day

Alternatively, may initiate therapy with a loading dose:
LOADING DOSE: 200 mg oral/IV once, followed in 12 hours with 100 mg oral/IV every 12 hours for at least 1 week; subsequent dose titrations should be performed as described above

• Due to increased incidence of CNS adverse reactions, the loading dose should be administered under medical supervision

Comments:

• Therapy may be administered either orally or via IV infusion using the same dosing regimen; IV infusion should preferably be over 30 to 60 minutes, although may be infused over 15 minutes if needed; experience with IV therapy is limited to 5 days of consecutive treatment.
• In adult clinical trials, adjunctive doses higher than 200 mg twice a day were not more effective and were associated with a substantially higher rate of adverse reactions.
• If converting from a single antiepileptic drug (AED) to lacosamide monotherapy, withdrawal of concomitant AED should not occur until a therapeutic dose of lacosamide has been achieved and administered for 3 days, then the concomitant AED may be gradually withdrawn over 6 weeks.

Use: As monotherapy for partial-onset seizures or adjunctive therapy for partial-onset seizures or primary generalized tonic-clonic seizures in patients 17 years and older

Usual Adult Dose for Seizures

MONOTHERAPY FOR PARTIAL-ONSET SEIZURES:
Initial dose: 100 mg orally twice a day

• Titrate in increments of 100 mg (50 mg twice a day) no more frequently than once a week based on clinical response and tolerability

Maintenance dose: 150 to 200 mg orally twice a day

ADJUNCTIVE THERAPY FOR PARTIAL-ONSET SEIZURES OR GENERALIZED TONIC-CLONIC SEIZURES: :
Initial dose: 50 mg orally twice a day

• Titrate in increments of 100 mg (50 mg twice a day) no more frequently than once a week based on clinical response and tolerability

Maintenance dose: 100 to 200 mg orally twice a day

Alternatively, may initiate therapy with a loading dose:
LOADING DOSE: 200 mg oral/IV once, followed in 12 hours with 100 mg oral/IV every 12 hours for at least 1 week; subsequent dose titrations should be performed as described above

• Due to increased incidence of CNS adverse reactions, the loading dose should be administered under medical supervision

Comments:

• Therapy may be administered either orally or via IV infusion using the same dosing regimen; IV infusion should preferably be over 30 to 60 minutes, although may be infused over 15 minutes if needed; experience with IV therapy is limited to 5 days of consecutive treatment.
• In adult clinical trials, adjunctive doses higher than 200 mg twice a day were not more effective and were associated with a substantially higher rate of adverse reactions.
• If converting from a single antiepileptic drug (AED) to lacosamide monotherapy, withdrawal of concomitant AED should not occur until a therapeutic dose of lacosamide has been achieved and administered for 3 days, then the concomitant AED may be gradually withdrawn over 6 weeks.

Use: As monotherapy for partial-onset seizures or adjunctive therapy for partial-onset seizures or primary generalized tonic-clonic seizures in patients 17 years and older

Usual Pediatric Dose for Epilepsy

AGE: 1 month or older:
WEIGHT: Less than 6 kg: Monotherapy Only

• Initial dose: 2 mg/kg/day as 0.66 mg/kg IV 3 times a day OR 1 mg/kg orally 2 times a day
• Titrate by 2 mg/kg/day no more frequently than once a week based on response and tolerability
• Maintenance dose: 7.5 to 15 mg/kg/day as 2.5 to 5 mg/kg IV 3 times a day OR 3.75 to 7.5 mg/kg orally 2 times a day

WEIGHT: 6 to less than 11 kg: Monotherapy Only

• Initial dose: 1 mg/kg oral/IV 2 times a day
• Titrate by 1 mg/kg twice a day no more frequently than once a week based on response and tolerability
• Maintenance dose: 3 to 6 mg/kg oral/IV twice a day

AGE: 4 to less than 17 years:
WEIGHT: 11 to less than 30 kg:

• Initial dose: 1 mg/kg oral/IV 2 times a day
• Titrate by 1 mg/kg oral/IV twice a day no more frequently than once a week based on response and tolerability
• Maintenance dose: 3 to 6 mg/kg oral/IV twice a day

WEIGHT: 30 to less than 50 kg:

• Initial dose: 1 mg/kg oral/IV twice a day
• Titrate by 1 mg/kg twice a day no more frequently than once a week based on clinical response and tolerability
• Maintenance dose: 2 to 4 mg/kg oral/IV twice a day

WEIGHT 50 kg or greater:

• Initial dose: 50 mg oral/IV twice a day
• Titrate by 50 mg twice a day no more frequently than once a week based on clinical response and tolerability
• MONOTHERAPY: Maintenance dose: 150 to 200 mg oral/IV twice a day
• ADJUNCTIVE THERAPY: Maintenance dose: 100 to 200 mg oral/IV twice a day

17 years and older: See Adult Dosing

Comments:

• The use of loading dose in pediatric patients has not been established.
• Oral and IV doses are the same unless specified; IV doses should be administered as an IV infusion over 30 to 60 minutes; experience with IV therapy is limited to 5 days of consecutive treatment.
• In adult clinical trials, adjunctive doses higher than 200 mg twice a day were not more effective and were associated with a substantially higher rate of adverse reactions.
• If converting from a from a single antiepileptic drug (AED) to lacosamide monotherapy, withdrawal of concomitant AED should not occur until a therapeutic dose of lacosamide has been achieved and administered for 3 days, then the concomitant AED may be gradually withdrawn over 6 weeks.

Uses: For the treatment of partial onset seizures in patients 1 month or older and as adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients 4 years or older.

Usual Pediatric Dose for Seizures

AGE: 1 month or older:
WEIGHT: Less than 6 kg: Monotherapy Only

• Initial dose: 2 mg/kg/day as 0.66 mg/kg IV 3 times a day OR 1 mg/kg orally 2 times a day
• Titrate by 2 mg/kg/day no more frequently than once a week based on response and tolerability
• Maintenance dose: 7.5 to 15 mg/kg/day as 2.5 to 5 mg/kg IV 3 times a day OR 3.75 to 7.5 mg/kg orally 2 times a day

WEIGHT: 6 to less than 11 kg: Monotherapy Only

• Initial dose: 1 mg/kg oral/IV 2 times a day
• Titrate by 1 mg/kg twice a day no more frequently than once a week based on response and tolerability
• Maintenance dose: 3 to 6 mg/kg oral/IV twice a day

AGE: 4 to less than 17 years:
WEIGHT: 11 to less than 30 kg:

• Initial dose: 1 mg/kg oral/IV 2 times a day
• Titrate by 1 mg/kg oral/IV twice a day no more frequently than once a week based on response and tolerability
• Maintenance dose: 3 to 6 mg/kg oral/IV twice a day

WEIGHT: 30 to less than 50 kg:

• Initial dose: 1 mg/kg oral/IV twice a day
• Titrate by 1 mg/kg twice a day no more frequently than once a week based on clinical response and tolerability
• Maintenance dose: 2 to 4 mg/kg oral/IV twice a day

WEIGHT 50 kg or greater:

• Initial dose: 50 mg oral/IV twice a day
• Titrate by 50 mg twice a day no more frequently than once a week based on clinical response and tolerability
• MONOTHERAPY: Maintenance dose: 150 to 200 mg oral/IV twice a day
• ADJUNCTIVE THERAPY: Maintenance dose: 100 to 200 mg oral/IV twice a day

17 years and older: See Adult Dosing

Comments:

• The use of loading dose in pediatric patients has not been established.
• Oral and IV doses are the same unless specified; IV doses should be administered as an IV infusion over 30 to 60 minutes; experience with IV therapy is limited to 5 days of consecutive treatment.
• In adult clinical trials, adjunctive doses higher than 200 mg twice a day were not more effective and were associated with a substantially higher rate of adverse reactions.
• If converting from a from a single antiepileptic drug (AED) to lacosamide monotherapy, withdrawal of concomitant AED should not occur until a therapeutic dose of lacosamide has been achieved and administered for 3 days, then the concomitant AED may be gradually withdrawn over 6 weeks.

Uses: For the treatment of partial onset seizures in patients 1 month or older and as adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients 4 years or older.

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl greater than 30 mL/min): No adjustment recommended
Severe renal dysfunction (CrCl less than 30 mL/min [adults] or CrCl less than 30 mL/min/1.73 m2 [pediatrics]) and ESRD: Maximum dose should be reduced by 25%

Dose titration should be performed with caution in patients with renal impairment

Liver Dose Adjustments

Mild to moderate hepatic impairment: Maximum dose should be reduced by 25%
Severe hepatic impairment: Not recommended

Dose titration should be performed with caution in patients with hepatic impairment

Dose Adjustments

Elderly: Dose titration should be cautious, usually starting at the lower end of the dosing ranges

Concomitant Use with Strong CYP450 3A4 or CYP450 2C9 Inhibitors:

• Lacosamide dose reduction may be necessary in patients with renal impairment or hepatic impairment

Therapy Discontinuation:

• Upon discontinuation, this drug should be withdrawn gradually over at least 1 week

Precautions

CONTRAINDICATIONS:

• None

Safety and efficacy have not been established in treating partial onset seizures in patients younger than 1 month
Safety and efficacy have not been established in treating primary generalized tonic-clonic seizures in patients younger than 4 years

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule V

Dialysis

Following a 4-hour hemodialysis treatment, dosage supplementation of up to 50% should be considered as this drug is effectively removed by hemodialysis

Other Comments

Administration advice:
Oral Tablets:

• May be taken with or without food
• Swallow whole with liquid; do not divide tablets

Oral Solution:

• May be taken with or without food
• 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 6 months 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 preferably over 30 to 60 minutes; if necessary, may infuse over 15 minutes in adults.
• 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 injection: Store at 20C to 25C (68F to 77F); Do not freeze
• Diluted IV solution should not be stored for more than 4 hours at room temperature
• Oral solution: Store at 20C to 25C (68F to 77F); do not freeze; discard unused oral solution 6 months after first opening bottle

General:

• This drug is associated with ECG changes that can cause irregular heart beats and syncope; use cautiously in patients with underlying proarrhythmic conditions, severe cardiac disease, cardiac sodium channelopathies, or those receiving concomitant medications that affect cardiac conduction; if used in these patients, obtain an ECG prior to initiation and after titrated to steady-state maintenance dose. If the IV route is used, increased monitoring is recommended.
• Patients with phenylketonuria (PKU) should be aware that the oral solution contains aspartame, a source of phenylalanine.

Monitoring:

• Cardiac: Obtain ECG before initiation and after titration to steady-state maintenance dose in patients with underlying proarrhythmic conditions, severe cardiac disease, cardiac sodium channelopathies, or those receiving concomitant medications that affect cardiac conduction
• Closely monitor patients receiving IV therapy
• Psychiatric: Monitor for unusual changes in mood or behavior, especially the emergence of suicidal thoughts or behaviors

Patient Advice:

• Read the US FDA-approved patient labeling (Medication Guide).
• Patients should be aware that this drug is associated with ECG changes that may predispose them to irregular heart beat and syncope; patients should be aware of the cardiac symptoms that should be reported promptly to their healthcare provider.
• 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 the 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.

Medical Disclaimer