ADIS DRUG EVALUATION
Lacosamide: A Review in Focal-Onset Seizures in Patients
with Epilepsy
Sheridan M. Hoy
1
Published online: 21 May 2018
Ó Springer International Publishing AG, part of Springer Nature 2018
Abstract Lacosamide (Vimpat
Ò
) is a functionalized amino
acid (available orally and intravenously) approved in the EU
and the USA for use as monotherapy and adjunctive therapy
for the treatment of focal-onset seizures in adults, adolescents
and children aged C 4 years with epilepsy. In adults and
adolescents (aged C 16 years), oral lacosamide as adjunctive
therapy to other antiepileptic drugs was generally effective in
reducing seizure frequency during short-term (up to
18 weeks) treatment, with efficacy sustained over the longer-
term (up to 8 years). Moreover, patients were effectively
switched from adjunctive oral lacosamide to the same dosage
of intravenous lacosamide. Oral lacosamide was an effective
conversion to monotherapy agent in this patient population
and as monotherapy demonstrated noninferiority to carba-
mazepine controlled release in terms of seizure freedom.
Antiepileptic benefits were maintained during longer-term
(B 2 years) monotherapy. The antiepileptic efficacy of laco-
samide in children aged C 4 years has been extrapolated from
data from adults and adolescents, with a similar response
expected provided paediatric dosage adaptations are used and
safety is demonstrated. Indeed, preliminary datademonstrated
the efficacy of short-term (16 weeks) adjunctive lacosamide
in patients aged C 4to\17 years. Oral lacosamide was
generally well tolerated over the short- and longer-term when
administered as adjunctive therapy, a conversion to
monotherapy agent and monotherapy in adults and
adolescents and when administered as adjunctive therapy in
children aged C 4 years. Thus, lacosamide is a useful option
for the management of focal-onset seizures across a broad age
range, starting as early as 4 years of age.
Lacosamide: clinical considerations in focal-onset
seizures in patients with epilepsy
Selectively enhances the slow inactivation of sodium
channels
Available as oral and intravenous formulations, with
switching between the formulations not requiring
dose adjustments
Provided effective seizure control as adjunctive
therapy, a conversion to monotherapy agent and
monotherapy in adults, adolescents and children
(aged C 4 years)
Antiepileptic benefits were sustained during
treatment for up to 8 years in extension studies
Generally well tolerated in adults, adolescents and
children, with most adverse events being mild or
moderate in intensity
1 Introduction
Antiepileptic drugs (AEDs) are the mainstay of treatment
for patients with epilepsy [1]. However, despite the number
of AEDs available for the treatment of focal-onset seizures
The manuscript was reviewed by: M. Mula, St George’s University
of London, London, UK; L. J. Stephen, Epilepsy Unit, West Glasgow
Ambulatory Care Hospital, Glasgow, UK.
& Sheridan M. Hoy
demail@springer.com
1
Springer, Private Bag 65901, Mairangi Bay, Auckland 0754,
New Zealand
CNS Drugs (2018) 32:473–484
https://doi.org/10.1007/s40263-018-0523-7
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