Three cases in which drug-induced hyponatremia was improved by replacing carbamazepine with lacosamide

Lacosamide in palliative medicine: a retrospective chart review

OBJECTIVES

To investigate the efficacy and safety of oral (PO) and subcutaneous (SC) lacosamide for refractory symptoms in the palliative setting.

METHODS

We conducted a retrospective chart review of the use of lacosamide since it was introduced in our palliative care service 1½ years ago. All clinical notes, medication administration records and infusion monitoring documentation were examined to ascertain therapeutic aim, efficacy, and tolerability.

RESULTS

Lacosamide was administered to 91 patients; 90% had cancer. The most common indication was neuropathic pain (97%); there appeared to be a significant improvement in 35%; this was sometimes apparent within a few hours of an SC loading 'test' dose. Many recipients (44%) were in their last month of life. 59% received one or more SC doses; switching from PO to SC lacosamide was straightforward and it appeared compatible with a range of other palliative medications. Lacosamide appeared well tolerated; adverse effects were identified in 11% (10/91), half of whom (5%, 5/91) discontinued treatment. Of 59 admixtures infused SC, one mild SC site reaction occurred that resolved with the addition of dexamethasone.

CONCLUSIONS

Lacosamide appears to be a promising option for refractory symptoms warranting further study; SC administration is an advantage when the PO route is lost.

Efficacy and tolerability of immediate switch from sodium channel blockers to Lacosamide

Lacosamide (LCM) is a new-generation anti-seizure medication approved for monotherapy and add-on therapy for focal-onset epilepsy. It has novel pharmacodynamics and favorable pharmacokinetic qualities with good clinical response. This study aims to evaluate the effectiveness and tolerability of LCM when used in the immediate switch from sodium channel blockers in patients with focal-onset and generalized-onset epilepsies. This retrospective, multicenter observational study was conducted with adult patients who received LCM as mono- or polytherapy through immediate switch with 6 to 52 months follow-up. The clinical data obtained during the follow-up period were analyzed to assess retention rate, seizure freedom, more than 50% seizure reduction, and adverse effects. A total of 32 patients (eight females, 24 males) with a median age of 49.75 (range, 23-86) years, median age at epilepsy onset of 32.58 (range, 0.5-85) years, and median epilepsy duration of 17.17 (range, 1-46) years were included in this study. Seizure frequency was between 1 and 90 in the past 6 months. Seven (21.9%) of the patients had structural brain lesions and 27 (84.4%) of the patients had EEG abnormalities. The adverse effects leading to switching were hyponatremia, rash, elevated liver enzymes, pain, and erectile dysfunction. At 14.34 (range, 6-52) months follow-up, 30 (93.75%) patients in total retained LCM, 20 (66.7%) of them were seizure-free, and 13 were on LCM monotherapy. Responder rate was 81.25%. Eight (25%) of the patients experienced adverse effects after the immediate switch. One patient with generalized-onset epilepsy needed to quit LCM due to an increase in seizures. Seizure frequency did not change in three patients in the focal-onset group. Immediate switch to LCM showed favorable outcomes with a significant reduction in seizure frequency, high retention rates, and tolerable adverse effect profiles in both focal-onset and generalized-onset seizures.