Lacosamide
Status epilepticus (alternative second-line), Focal seizures
Indications
- Status epilepticus (alternative second-line)
- Focal seizures
Adult dosing
- status epilepticus: dose: 400; unit: mg; route: IV over 15 min; fixed: true; maintenance: dose: 200; unit: mg; route: IV/PO BID; fixed: true
Pediatric dosing
- status epilepticus: dose: 5; unit: mg/kg; maxDose: 200; maxDoseAbsolute: true; route: IV over 15 min; weightBased: true; pedNote: Use in children >4 years only
Contraindications
- Second or third-degree AV block (without pacemaker)
Clinical pearls
- Useful when other agents are contraindicated (e.g., valproate in pregnancy/liver disease)
- Minimal drug interactions — does not induce/inhibit CYP enzymes
- Can cause PR prolongation — ECG monitoring recommended
- Loading dose 200-400mg IV; some evidence supports up to 400mg
Source and review
- Neurocritical Care Society; AES. Last reviewed: 2024-11-01