Dose of Lacosamide

Dosing: Adult (Uptodate)

Partial onset seizure:

Monotherapy: Oral, IV:

Initial: 100 mg twice daily; may be increased at weekly intervals by 50 mg twice daily based on response and tolerability.

Alternative initial dosage: Loading dose: 200 mg followed approximately 12 hours later by 100 mg twice daily for 1 week; may be increased at weekly intervals by 50 mg twice daily based on response and tolerability. Note: Administer loading doses under medical supervision because of the increased incidence of CNS adverse reactions.

Maintenance: 150 to 200 mg twice daily. Note: For patients already on a single antiepileptic and converting to lacosamide monotherapy, maintain the maintenance dose for 3 days before beginning withdrawal of the concomitant antiepileptic drug. Gradually taper the concomitant antiepileptic drug over ≥6 weeks.

Adjunctive therapy: Oral, IV:

Initial: 50 mg twice daily; may be increased at weekly intervals by 50 mg twice daily based on response and tolerability.

Alternative initial dosage: Loading dose of 200 mg followed approximately 12 hours later by 100 mg twice daily for 1 week; may be increased at weekly intervals by 50 mg twice daily based on response and tolerability. Note: Administer loading doses under medical supervision because of the increased incidence of CNS adverse reactions.

Maintenance dose: 100 to 200 mg twice daily (maximum: 400 mg daily)

Status epilepticus, refractory (off-label use): IV: 200 to 400 mg followed by a daily maintenance dose of 200 to 600 mg daily in 2 divided doses (Albers, 2011; Goodwin, 2011; Kellinghaus, 2011; NCS [Brophy, 2012]). Note: Although the Neurocritical Care Society recommends administration of the initial dose at a rate of 200 mg over 15 minutes, others have administered doses of up to 400 mg IV push over ≤5 minutes without apparent harm (Goodwin, 2011; Kellinghaus, 2011; NCS [Brophy, 2012]).