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Lacosamide

AEMPS

Antiepileptic – selective sodium channel modulator

ATC code: N03AX18

Updated · Methodology

Indications

A

Focal epilepsy

First line

First-line in focal epilepsy in adults and children over 4 per ILAE 2017 and the Spanish SEN 2024 alongside lamotrigine and levetiracetam. Starting dose 50 mg twice daily, titrated to 200–400 mg/day. In women of reproductive age, advantageous over carbamazepine and phenytoin because it does not induce CYP – does not reduce oral contraceptive or other drug efficacy.

Sources

  1. AEMPS: Ficha técnica de Lacosamida (2024)
  2. Lancet Neurol: Efficacy, safety, and tolerability of lacosamide monotherapy versus controlled-release carbamazepine in patients with newly diagnosed epilepsy: a phase 3, randomised, double-blind, non-inferiority trial. (2017)
  3. Cochrane Database Syst Rev: Lacosamide add-on therapy for focal epilepsy. (2021)
  4. Acta Neurol Scand: Antiepileptic monotherapy in newly diagnosed focal epilepsy. A network meta-analysis. (2019)

ICD-10: G40.2 · ICD-11: 8A60

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

F

Memory and concentration enhancement

Not recommended

Lacosamide is an antiepileptic drug prescribed for focal epilepsy ( 2018 guidelines). In biohacker circles, lacosamide is sometimes promoted as a nootropic with sodium-channel modulation for healthy adults. No clinical studies in healthy adults exist. The drug has specific risks: PR-interval prolongation and atrioventricular block (especially in people with cardiac disease), dizziness, nausea, and double vision. If lacosamide was recommended for concentration or brain function in a healthy person, consider seeking a second opinion.

Sources

  1. AEMPS: Ficha técnica de Lacosamida (2024)
  2. Cochrane: Ginkgo biloba for cognitive impairment and dementia (2009)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Enhances slow inactivation of voltage-gated sodium channels in neurons – differs from other antiepileptics targeting fast inactivation (carbamazepine, phenytoin). Stabilizes hyperactive neurons without suppressing physiological function. Minimal interactions with other antiepileptics and oral contraceptives. Half-life 13 hours, dosed twice daily. Available in oral and parenteral forms.

Safety

Contraindications

  • Lacosamide hypersensitivity
  • Second- or third-degree AV block
  • Severe hepatic impairment
  • Age under 4

Serious adverse effects

  • PR prolongation and AV block
  • Ventricular arrhythmias
  • DRESS syndrome
  • Suicidal thoughts
  • Euphoria and abuse potential

Common adverse effects

  • Dizziness
  • Headache
  • Nausea
  • Diplopia
  • Drowsiness
  • Ataxia

Pregnancy: can you take Lacosamide?

Limited pregnancy data. Lamotrigine and levetiracetam with more data and better teratogenic profile are preferred in pregnant epilepsy patients.

Breastfeeding: can you take Lacosamide?

Lacosamide passes into milk. Use during lactation cautiously with monitoring of infant drowsiness.

Calculate RIDFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take twice daily, with or without food, preferably at the same time. Before start and periodically check ECG (PR prolongation, AV block) – especially with other PR-prolonging drugs (β-blockers, calcium antagonists, class I antiarrhythmics). With eGFR under 30, halve the dose. Not used in severe hepatic impairment.
Label mentions24 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

  • Moderateantiarrítmicosclass named in the label
    «Lacosamida debe usarse con precaución en pacientes tratados con medicamentos conocidos por estar asociados con prolongación del PR (incluyendo los medicamentos antiepilépticos bloqueantes de canales…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderatebeta blockersclass named in the label
    «Concomitant Medications that Affect Cardiac Conduction: Lacosamide should be used with caution in patients on concomitant medications that affect cardiac conduction (sodium channel blockers…»

    FDA, section 7 · Open on DailyMed

  • Moderatecalcium channel blockersclass named in the label
    «Concomitant Medications that Affect Cardiac Conduction: Lacosamide should be used with caution in patients on concomitant medications that affect cardiac conduction (sodium channel blockers…»

    FDA, section 7 · Open on DailyMed

  • ModerateCarbamazepine
    «Lacosamida debe usarse con precaución en pacientes tratados con medicamentos conocidos por estar asociados con prolongación del PR (incluyendo los medicamentos antiepilépticos bloqueantes de canales…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateClarithromycin
    «Datos In vivo: Omeprazol (40 mg una vez al día), inhibidor del CYP2C19, no ocasionó un cambio clínicamente significativo en la exposición a lacosamida. Por lo que, es poco probable que inhibidores…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateCYP2C9 inhibitorsclass named in the label
    «Strong CYP3A4 or CYP2C9 Inhibitors: Patients with renal or hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 may have a significant increase in exposure to lacosamide. Dose…»

    FDA, section 7 · Open on DailyMed

  • ModerateFluconazole
    «Datos In vivo: Omeprazol (40 mg una vez al día), inhibidor del CYP2C19, no ocasionó un cambio clínicamente significativo en la exposición a lacosamida. Por lo que, es poco probable que inhibidores…»

    AEMPS, section 4.5 · Open on CIMA

  • Moderateinhibidores del CYP2C9class named in the label
    «Datos In vivo: Omeprazol (40 mg una vez al día), inhibidor del CYP2C19, no ocasionó un cambio clínicamente significativo en la exposición a lacosamida. Por lo que, es poco probable que inhibidores…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateItraconazole
    «Datos In vivo: Omeprazol (40 mg una vez al día), inhibidor del CYP2C19, no ocasionó un cambio clínicamente significativo en la exposición a lacosamida. Por lo que, es poco probable que inhibidores…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateKetoconazole
    «Datos In vivo: Omeprazol (40 mg una vez al día), inhibidor del CYP2C19, no ocasionó un cambio clínicamente significativo en la exposición a lacosamida. Por lo que, es poco probable que inhibidores…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateLamotrigine
    «Lacosamida debe usarse con precaución en pacientes tratados con medicamentos conocidos por estar asociados con prolongación del PR (incluyendo los medicamentos antiepilépticos bloqueantes de canales…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateRifampicin
    «Datos In vivo: Los inductores enzimáticos fuertes como la rifampicina o la hierba de San Juan ( Hypericum perforatum ) pueden reducir moderadamente la exposición sistémica a lacosamida. Por tanto, el…»

    AEMPS, section 4.5 · Open on CIMA

  • ModerateRitonavir
    «Datos In vivo: Omeprazol (40 mg una vez al día), inhibidor del CYP2C19, no ocasionó un cambio clínicamente significativo en la exposición a lacosamida. Por lo que, es poco probable que inhibidores…»

    AEMPS, section 4.5 · Open on CIMA

  • anticonceptivos hormonalesclass named in the label
    «Anticonceptivos orales: En un estudio de interacción no hubo interacción clínicamente relevante entre lacosamida y los anticonceptivos orales etinilestradiol y levonorgestrel. Las concentraciones de…»

    AEMPS, section 4.5 · Open on CIMA

  • Digoxin
    «Otras: Estudios de interacción mostraron que lacosamida no tiene efecto sobre la farmacocinética de digoxina. No hubo interacción clínicamente relevante entre lacosamida y metformina.»

    AEMPS, section 4.5 · Open on CIMA

  • Ethinylestradiol
    «Anticonceptivos orales: En un estudio de interacción no hubo interacción clínicamente relevante entre lacosamida y los anticonceptivos orales etinilestradiol y levonorgestrel. Las concentraciones de…»

    AEMPS, section 4.5 · Open on CIMA

  • Levonorgestrel
    «Anticonceptivos orales: En un estudio de interacción no hubo interacción clínicamente relevante entre lacosamida y los anticonceptivos orales etinilestradiol y levonorgestrel. Las concentraciones de…»

    AEMPS, section 4.5 · Open on CIMA

  • Metformin
    «Otras: Estudios de interacción mostraron que lacosamida no tiene efecto sobre la farmacocinética de digoxina. No hubo interacción clínicamente relevante entre lacosamida y metformina.»

    AEMPS, section 4.5 · Open on CIMA

  • Phenobarbital
    «Medicamentos antiepilépticos: En estudios de interacción lacosamida no afectó significativamente las concentraciones plasmáticas de carbamazepina y ácido valproico. Las concentraciones plasmáticas de…»

    AEMPS, section 4.5 · Open on CIMA

  • Phenytoin
    «Medicamentos antiepilépticos: En estudios de interacción lacosamida no afectó significativamente las concentraciones plasmáticas de carbamazepina y ácido valproico. Las concentraciones plasmáticas de…»

    AEMPS, section 4.5 · Open on CIMA

  • Valproic acid
    «Medicamentos antiepilépticos: En estudios de interacción lacosamida no afectó significativamente las concentraciones plasmáticas de carbamazepina y ácido valproico. Las concentraciones plasmáticas de…»

    AEMPS, section 4.5 · Open on CIMA

  • Warfarin
    «Otras: La administración concomitante de warfarina con lacosamida no da como resultado un cambio clínicamente relevante en la farmacocinética y farmacodinamia de la warfarina.»

    AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

  • Lamotrigine
    «Fármacos que tienen poco o ningún efecto en la concentración de lamotrigina: Lacosamida»

    AEMPS, section 4.5 · Open on CIMA

  • Phenytoin
    «Drugs Affected by Phenytoin: Antiepileptic drugs The effect of phenytoin on phenobarbital, valproic acid and sodium valproate serum levels is unpredictable Carbamazepine, felbamate, lamotrigine…»

    FDA, section 7 · Open on DailyMed

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Frequently asked

What is Lacosamide used for?

Lacosamide is evaluated for the following indications with varying evidence strength: Focal epilepsy (evidence tier A), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Lacosamide?

Common side effects of Lacosamide (≥ 1 in 100): Dizziness, Headache, Nausea, Diplopia, Drowsiness, Ataxia. See the Safety section for uncommon and serious reactions.

Is Lacosamide safe during pregnancy?

Limited pregnancy data. Lamotrigine and levetiracetam with more data and better teratogenic profile are preferred in pregnant epilepsy patients.

Is Lacosamide compatible with breastfeeding?

Lacosamide passes into milk. Use during lactation cautiously with monitoring of infant drowsiness.

Who should not take Lacosamide?

Lacosamide is contraindicated in: Lacosamide hypersensitivity; Second- or third-degree AV block; Severe hepatic impairment; Age under 4. Full list in the Safety section.

Official sources

Direct links to regulator labels. Open in a new tab.

Other drugs in this group

Lamotrigine, Levetiracetam, Phenobarbital, Phenytoin, Valproic acid, Carbamazepine, Pregabalin, Topiramate