Lacosamide

Introduction

Written by Patricia Weiser, PharmD
Medically reviewed by Amber Watson, PharmD
Updated on August 21, 2023

Lacosamide (la KOE sa mide) is a generic medication prescribed for certain types of seizures. It’s used in adults and some children with epilepsy. Lacosamide belongs to a group of drugs called antiepileptics (AEDs).

Side effects of lacosamide

Lacosamide may cause mild or serious side effects. More common mild side effects of lacosamide and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about lacosamide’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for lacosamide listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of lacosamide are listed below. These side effects may differ based on the form of lacosamide your doctor prescribes.

This article doesn’t include all possible mild side effects of the drug. To learn more about lacosamide’s side effects based on the form, refer to the prescribing information for lacosamide listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of lacosamide oral solution, injection, and oral tablets may include:

• diplopia (double vision)
• headache
• dizziness
• nausea
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for lacosamide” section.

Serious side effects

Serious side effects of lacosamide are listed below. These side effects may differ based on the form of lacosamide your doctor prescribes.

This article doesn’t include all possible serious side effects of the drug. To learn more about lacosamide’s side effects based on the form, refer to the prescribing information for lacosamide listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, lacosamide’s serious side effects may include:

• changes in heart rhythm or electrical activity in the heart
• depression
• suicidal thoughts or behavior
• problems with coordination and balance, which may cause trouble walking
• drowsiness, which may make it unsafe to drive or operate machinery
• a rare but serious type of drug reaction, known as eosinophilia and systemic symptoms (DRESS), that affects the liver, kidneys, and possibly other organs
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for lacosamide” section.

Suicide prevention

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

• Call the 988 Suicide and Crisis Lifeline at 988.
• Text HOME to the Crisis Textline at 741741.
• Not in the United States? Find a helpline in your country with Befrienders Worldwide.
• Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

Common questions about lacosamide

Below you’ll find answers to a few commonly asked questions about lacosamide.

Is lacosamide a controlled substance?

Yes, lacosamide is a controlled substance. A controlled substance is a drug the government regulates due to the risk of dependence or misuse. (With misuse, a drug is taken in a way other than how it’s prescribed. And dependence means the body needs the drug in order to function as usual.)

Specifically, lacosamide is a Schedule V (five) controlled substance. Drugs in this category have a relatively low potential for misuse compared with other controlled substances.

Since lacosamide may cause dependence, it’s important not to suddenly stop treatment. Doing so could lead to withdrawal symptoms, including seizures. (Withdrawal symptoms can occur when you stop taking a drug your body has become dependent on.)

If you and your doctor decide you’ll stop lacosamide treatment, your doctor will instruct you on how to gradually reduce your dose over at least one week before stopping it.

Talk with your doctor if you have questions about what to expect with lacosamide treatment.

How does lacosamide work? And how long does it take to start working?

It isn’t completely understood how lacosamide works to treat seizures. Seizures are thought to occur when nerve cells in the brain are stimulated too much, causing a surge of electrical activity in the brain.

Lacosamide is thought to work by slowing the stimulation of nerve cells in the brain. In doing so, lacosamide calms electrical activity in the brain.

It may take several weeks for lacosamide to start working to reduce the frequency or severity of seizures. Doctors often need to raise or adjust the dosage of lacosamide during the first several weeks of treatment until they find the right dosage to manage a person’s seizures. 

If you have questions about lacosamide’s mechanism of action (how it works) to treat your condition, talk with your doctor or pharmacist.

Is lacosamide similar to Keppra?

Yes, lacosamide is similar to levetiracetam (Keppra). Both medications belong to a group of drugs called antiepileptics. They’re both used to treat focal onset seizures (also called partial seizures) in adults and some children.

But there are some differences between the two drugs. Levetiracetam is approved to treat other types of seizures, while lacosamide is not. Also, lacosamide has more drug interactions than levetiracetam.

To learn more about how lacosamide compares with levetiracetam, talk with your doctor or pharmacist.

Uses of lacosamide

The Food and Drug Administration (FDA) approves prescription drugs such as lacosamide for certain conditions. Approved uses for lacosamide are described below.

Use for seizures

Doctors may prescribe lacosamide oral solution or lacosamide oral tablet for treating focal onset seizures (also called partial seizures). It’s used for this purpose in adults and children ages 4 years and older. It’s usually prescribed as a long-term treatment.

Lacosamide injection is also used for focal onset seizures. It’s prescribed for people ages 17 years and older. Doctors generally prescribe lacosamide injection as a short-term treatment. It’s typically given as an intravenous (IV) infusion* in a hospital.

Seizures are thought to occur when excessive stimulation of nerve cells causes a surge of electrical activity in the brain. A focal seizure starts in just one area of the brain. The symptoms depend on the affected area of the brain, but may include:

• muscle contractions on one side of your body
• unusual movements of the head or eyes
• repeating actions like lip-smacking, swallowing, and tapping
• staring blankly

Lacosamide may be prescribed alone or together with other antiepileptic drugs (AEDs) for treating seizures. Examples of other AEDs include carbamazepine, gabapentin, and valproic acid.

* This is an injection that’s given into your vein over a period of time.

Interactions and warnings for lacosamide

Below, you’ll find information about lacosamide’s possible interactions and warnings.

Interactions of lacosamide

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you start lacosamide, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for lacosamide” section below.

Warnings for lacosamide

Some people should not take or use lacosamide, and others should take or use it cautiously.

Lacosamide could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether lacosamide is a safe option for you. These warnings may differ based on the form of lacosamide your doctor prescribes.

Ask your doctor about specific warnings for lacosamide, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Lacosamide can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to lacosamide or any of its ingredients, your doctor will likely not prescribe lacosamide. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to lacosamide, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of lacosamide

If you take lacosamide by mouth, you should not take more lacosamide than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much lacosamide, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and lacosamide

Information about lacosamide and pregnancy and breastfeeding is described below.

Lacosamide and pregnancy

It’s not known whether lacosamide should be taken or used during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before starting this medication.

If you become pregnant while taking lacosamide, your doctor may encourage you to enroll in the North American Antiepileptic Drug Pregnancy Registry. This registry collects information about how seizure medications, such as lacosamide, may affect pregnancy.

To learn more, talk with your doctor or call 888-233-2334.

Lacosamide and breastfeeding

There are risks to taking or using lacosamide while breastfeeding. For instance, lacosamide may cause excessive sleepiness in a breastfed child.

But there are also risks with having untreated seizures during this time. (Keep in mind that lacosamide is used for treating certain types of seizures.)

If you’re planning to breastfeed, talk with your doctor about seizure treatment options. Together, you can discuss the risks and benefits of your treatment options and decide whether you should take lacosamide during this time. Your doctor may recommend other healthy ways to feed your child.

What to ask your doctor

Let your doctor know if you have questions about lacosamide or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• What are my options if lacosamide is too expensive for me?
• Should I continue taking my other seizure medication with lacosamide?
• Can lacosamide cause weight gain or hearing problems?
• Can I take lacosamide if I have kidney or liver problems?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Lacosamide injection, for intravenous use, CV. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/6b4536d0-5703-42b0-9f59-46a3e1b75b22/spl-doc
• Lacosamide oral solution, CV. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/45786c84-51ef-4440-bc88-2501951e4c41/spl-doc
• Lacosamide tablets, film coated tablet, for oral use, CV. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/ecb8b33e-7cbd-4f5e-9fe9-e72dff9bcb86/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.