Lacosamide

 Issues for Surgery

Precipitation of rebound seizures or status epilepticus if omitted.

  Advice in the Perioperative period

Elective and Emergency Surgery

Continue.

Patients should be advised to take their regular medications on the day of surgery^{1, 2, 3}.

Abrupt withdrawal of any anticonvulsant drug should be avoided¹.

Confirm with the patient if they need to be maintained on a specific manufacturer’s product (see Further Information).

Post-operative Advice

Regular dosing of the patient’s usual oral medication should be re-established as early as possible post-operatively^{2, 3}.

If patients are unable to take their regular oral medication post-operatively, consider using the intravenous route. The intravenous dose and frequency should be the same as the established oral dose¹.

  Interaction(s) with Common Anaesthetic Agents

For general information regarding the use of anaesthetic agents in epilepsy patients – see ‘Antiepileptics – A General Overview’.

None^{1, 2, 3, 4, 5}.

  Interaction(s) with other Common Medicines used in the Perioperative Period

For general information regarding the use of antiemetics in epilepsy patients – see ‘Antiepileptics – A General Overview’.

Antimicrobials

Clarithromycin is predicted to increase the plasma concentration of lacosamide (due to its potential to inhibit CYP3A4)^{4, 5}. Bear the theoretical potential for an interaction in mind should an increase in lacosamide adverse effects (such as nausea, dizziness, diplopia) occur. Consider reducing the lacosamide dose in patients with hepatic or renal impairment⁴.

Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring. Consult current product literature.

  Further Information

MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products (November 2017)¹

Lacosamide is a category 3 antiepileptic, hence it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product as therapeutic equivalence can be assumed. However, other factors are important when considering if switching is appropriate such as patient anxiety, risk of confusion or dosing errors. (For more information see ‘Antiepileptics – A General Overview’).

  References

1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed 3^rd July 2019]
2. Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy BJA: British Journal of Anaesthesia. 2012; 108(4):562-571
3. Carter EL, Adapa RM. Adult epilepsy and anaesthesia. BJA Education. 2015; 15(3):111-117
4. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 19^th July 2019]
5. Summary of Product Characteristics – Vimpat^® (lacosamide) film-coated tablets. UCB Pharma Limited. Accessed via www.medicines.org.uk 18/07/2019 [date of revision of the text September 2018]