Lacosamide ER
MOTPOLY XR
Pronunciation: la-KOE-sa-mide (mot-PAH-lee)
“Monopoly Lacrosse (vampire)”
What it isOnce-daily extended-release lacosamide; partial-onset seizures, and adjunct for primary generalized tonic-clonic seizures (adults and children of at least 50 kg).
Why this oneThe same slow-inactivation sodium-channel drug as twice-daily VIMPAT, in one daily dose.
What limits itDose-dependent PR prolongation, AV block and ventricular tachyarrhythmia, so caution with conduction disease. Dizziness and diplopia are dose-limiting; Schedule V.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Partial-onset seizures (monotherapy) | Adults (17 yr and older) | 200 mg QD | 300-400 mg QD | 400 mg QD |
| Partial-onset seizures (adjunctive) | Adults (17 yr and older) | 100 mg QD | 200-400 mg QD | 400 mg QD |
| Primary generalized tonic-clonic seizures (adjunctive) | Adults (17 yr and older) | 100 mg QD | 200-400 mg QD | 400 mg QD |
| Partial-onset seizures / adjunctive PGTC | Pediatric weighing >=50 kg | 100 mg QD | 300-400 mg QD (monotherapy) / 200-400 mg QD (adjunctive) | 400 mg QD |
Titration Increase by 100 mg QD no more frequently than once per week
Renal No adjustment for mild-moderate; severe (CrCl <30) or ESRD: max 300 mg QD; supplement up to 50% after hemodialysis
Hepatic Mild-moderate: max 300 mg QD; not recommended in severe hepatic impairment
Instructions
- Swallow capsules whole with liquid; do not open, chew, or crush
- May be taken with or without food
- On discontinuation, withdraw gradually over at least 1 week
Available strengths
- ER cap 100, 150, 200 mg
- tab 50, 100, 150, 200 mg
- sol 10 mg/mL
- inj 10 mg/mL
Cautions
- Suicidal behavior and ideation
- Dizziness and ataxia
- Cardiac rhythm and conduction abnormalities (PR prolongation, AV block, ventricular tachyarrhythmia); obtain ECG in patients with proarrhythmic conditions
- Atrial fibrillation/flutter
- Syncope
- Withdraw gradually to minimize increased seizure frequency
- DRESS/multi-organ hypersensitivity
Adverse reactions
- Diplopia
- Headache
- Dizziness
- Nausea
- Somnolence
- Vomiting
- Fatigue
- Ataxia
- Tremor
Pregnancy Available human data insufficient to identify drug-associated risk; animal data show developmental toxicity. Pregnancy exposure registry (NAAED) available.
Lactation Lacosamide present in human milk; reports of increased sleepiness in breastfed infants - monitor for excess sedation.
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 100 mg | ER cap | 30 qd | — | $642.90 | not offered |
| 150 mg | ER cap | 30 qd | — | $645.06 | not offered |
| 200 mg | ER cap | 30 qd | — | $645.33 | not offered |
Other forms: Lacosamide (VIMPAT)
NO BOXED WARNINGS
Principal riskPR prolongation and dizziness
Classes and tags
Clinical profile
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