Safety & pK of IV loading dose of lacosamide in the ICU

Recent advances in status epilepticus

“…The most often used dose is 200-400 mg for adults as fast infusion over 5-10 min [95,96]. A safety and pharmacokinetics study recently exploring a weight-based approach to intravenous loading dosing of lacosamide found that a loading dose of 10-12 mg/kg at an infusion rate of 0.4 mg/kg/min is well tolerated and will produce levels at least 15 m/ml [97].…”

Intravenous lacosamide in status epilepticus: Correlation between loading dose, serum levels, and clinical response

“…Boluses of 200-400mg are usually administered in SE (Höfler and Trinka, 2013), and a small prospective study suggested that 400mg could possibly prove more efficacious than 200mg (Legros et al, 2014). It was recently observed that loading doses of 8mg/kg (approximately 550 mg for a 70kg patient) were needed to reach a serum level within the reference interval (Ramsay et al, 2015) and that doses of more than 10-12mg/kg resulted in levels above 15 mg/l . Measurements of serum levels could represent a useful surrogate marker of exposition to ascertain the clinical response in SE.…”

Lacosamide in status epilepticus: Systematic review of current evidence

“…Because LCM acts on voltage‐gated sodium channels, treatment‐induced atrioventricular (AV) block is a possible concern, especially in cases of a rapid intravenous LCM application. Using a loading dose of 12 mg/kg LCM over 30 min and an infusion rate of 0.4 mg/kg/min, a mean increase in PR interval of 7.3 msec was shown for a 400 mg/day, and of 11.9 msec for an 800 mg/day maintenance dose group . In another study of 98 patients, two of them presented cardiac adverse events (1.8%) .…”

“…Using a loading dose of 12 mg/kg LCM over 30 min and an infusion rate of 0.4 mg/kg/min, a mean increase in PR interval of 7.3 msec was shown for a 400 mg/day, and of 11.9 msec for an 800 mg/day maintenance dose group. 76 In another study of 98 patients, two of them presented cardiac adverse events (1.8%). 53 A 77-yearold patient with ischemic cardiopathy showed an asymptomatic PR prolongation under a dosage of 200 mg/day LCM after previously administration of benzodiazepine LEV, and valproate (no concomitant dromotropic medication).…”