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Antiepileptic — Sodium Channel Slow Inactivation Enhancer

Lacosamide

Brand names: Vimpat

Lacosamide is an antiepileptic used for focal (partial-onset) seizures, as monotherapy or add-on therapy. An intravenous formulation is available for when oral treatment is temporarily not feasible.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Adults (17 years and older): Initial dosage for monotherapy for the treatment of partial-onset seizures is 100 mg twice daily (2.1) Initial dosage for adjunctive therapy for the treatment of partial-onset seizures or primary generalized tonic-clonic seizures is 50 mg twice daily (2.1) Maximum recommended dosage for monotherapy and adjunctive therapy is 200 mg twice daily (2.1) Pediatric Patients 4 years to less than 17 years : The recommended dosage is based on body weight and is administered orally twice daily (2.1) Increase dosage based on clinical response and tolerability, no more frequently than once per week (2.1) Injection: for intravenous use only when oral administration is …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-10-16. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It selectively enhances the slow inactivation of voltage-gated sodium channels, stabilising hyperexcitable neuronal membranes and reducing repetitive firing.

Prescribing in practice

  • It can prolong the PR interval — use with caution in known cardiac conduction problems, with other PR-prolonging drugs, or in severe cardiac disease, and obtain a baseline ECG where clinically relevant.
  • Dizziness, double vision and unsteadiness are common and tend to be dose-related.
  • Titrate gradually and reduce the dose in significant renal or hepatic impairment; withdraw slowly rather than stopping abruptly.

Monitoring

Assess cardiac conduction risk before starting, with ECG where relevant; review seizure control, dose-related neurological side effects, and mood or suicidal ideation as with all antiepileptics.

Counselling the patient

  • Dizziness and double vision are common, especially when starting or increasing the dose — take care with driving and tasks needing balance.
  • Do not stop the medicine suddenly, as this can provoke seizures.
  • Report palpitations, fainting or a markedly irregular pulse.

Evidence & guidelines

Licensed and guideline-recognised option for focal seizures (NICE NG217).

Reference: NICE NG217; EMA Vimpat SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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