Advertisement

Lacosamide: a Study of Exposures Reported to US Poison Centers over a 9-Year Period

  • John TeijidoEmail author
  • Derek Kempf
  • Elizabeth Laubach
  • Amy Zosel
  • Douglas Borys
Original Article
  • 13 Downloads

Abstract

Background

Lacosamide (Vimpat®) is an anticonvulsant used to treat partial-onset seizures. Little is known about the characteristics and outcomes of patients exposed to lacosamide.

Objective

To characterize lacosamide exposures reported to US poison centers with regard to patient demographics, clinical effects, and outcomes.

Methods

This retrospective observational study queried the National Poison Data System (NPDS) for single substance lacosamide exposures from January 2008 to December 2016. Variables of interest included age, gender, medical outcome, management site, level of healthcare facility, reason for exposure, and clinical effects.

Results

Lacosamide exposures were identified in 1124 patients, ranging from ages 2 months to 99 years. Six hundred and twenty-two patients (55.3%) were female. Nine hundred and seventy-six patients (86.8%) had minimal or no toxic effects. Life-threatening exposures numbered 30 cases (2.7%). There was one death. Five hundred and forty-eight patients (48.8%) did not require healthcare management while 537 (47.7%) were either referred to or already at a hospital. Among those treated at a healthcare facility, 269 (50.1%) did not require admission. Thirty-three patients (6.1%) were admitted to a psychiatric facility, 68 (12.7%) to a non-critical care unit, and 93 (17.3%) to a critical care unit. Six hundred and thirty-two exposures (56.2%) were due to therapeutic error. Suicide attempts numbered 168 (14.9%). Neurologic, gastrointestinal, and cardiovascular symptoms were commonly encountered.

Conclusion

Lacosamide exposures infrequently cause death or disability; however, a considerable proportion of the study population required intensive care. Exposed patients with symptoms require healthcare evaluation.

Keywords

Lacosamide National Poison Data System Overdose Vimpat 

Notes

Compliance with Ethical Standards

This study was approved by the Concordia University Wisconsin institutional review board.

Conflict of Interest

None.

References

  1. 1.
    Husain A, Chung S, Faught E, Isojarvi J, McShea C, Doty P. Long-term safety and efficacy in patients with uncontrolled partial-onset seizures treated with adjunctive lacosamide: results from a phase III open-label extension trial. Epilepsia. 2012;53(3):521–8.  https://doi.org/10.1111/j.1528-1167.2012.03407.x.CrossRefGoogle Scholar
  2. 2.
    VIMPAT ® (lacosamide): medication guide. 2014. 1–2.Google Scholar
  3. 3.
    Bauer S, David Rudd G, Mylius V, Hamer HM, Rosenow F. Lacosamide intoxication in attempted suicide. Epilepsy Behav: E&B. 2010;17(4):549–51.  https://doi.org/10.1016/j.yebeh.2010.01.007.CrossRefGoogle Scholar
  4. 4.
    Chinnasami S, Rathore C, Duncan JS. Sinus node dysfunction: an adverse effect of lacosamide. Epilepsia. 2013;54(6):e90–3.  https://doi.org/10.1111/epi.12108.CrossRefGoogle Scholar
  5. 5.
    Degiorgio CM. Atrial flutter/atrial fibrillation associated with lacosamide for partial seizures. Epilepsy & Behavior : E&B. 2010;18(3):322–4.  https://doi.org/10.1016/j.yebeh.2010.04.043.CrossRefGoogle Scholar
  6. 6.
    Krause LU, Brodowski KO, Kellinghaus C. Atrioventricular block following lacosamide intoxication. Epilepsy Behav : E&B. 2011;20(4):725–7.  https://doi.org/10.1016/j.yebeh.2011.02.006.CrossRefGoogle Scholar
  7. 7.
    Malissin I, Baud FJ, Deveaux M, Champion S, Deye N, Megarbane B. Fatal lacosamide poisoning in relation to cardiac conduction impairment and cardiovascular failure. Clinical Toxicology (Philadelphia, Pa.). 2013;51(4):381–2.  https://doi.org/10.3109/15563650.2013.778993.CrossRefGoogle Scholar
  8. 8.
    Nizam A, Mylavarapu K, Thomas D, Briskin K, Wu B, Saluja D, et al. Lacosamide-induced second-degree atrioventricular block in a patient with partial epilepsy. Epilepsia. 2011;52(10):e153–5.  https://doi.org/10.1111/j.1528-1167.2011.03212.x.CrossRefGoogle Scholar
  9. 9.
    Shaibani A, Fares S, Selam JL, Arslanian A, Simpson J, Sen D, et al. Lacosamide in painful diabetic neuropathy: an 18-week double-blind placebo-controlled trial. J Pain. 2009;10(8):818–28.  https://doi.org/10.1016/j.jpain.2009.01.322.CrossRefGoogle Scholar
  10. 10.
    Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 annual report of the American Association Of Poison Control Centers’ National Poison Data System (NPDS): 34th annual report. Clinical Toxicology (Philadelphia, Pa). 2017;55(10):1072–254.  https://doi.org/10.1080/15563650.2017.1388087.CrossRefGoogle Scholar
  11. 11.
    AAPCC National Poison Data System (NPDS). Reference manual. Washington, DC: American Association of Poison Control Centers; 2014.Google Scholar
  12. 12.
    Bronstein A, Spyker D, Cantilena L, et al. 2007 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 25th annual report. Clin Toxicol (Philadelphia, Pa.). 2008;46:927–1057.CrossRefGoogle Scholar
  13. 13.
    Buck ML, Goodkin HP. Use of lacosamide in children with refractory epilepsy. The Journal of Pediatric Pharmacology and Therapeutics : JPPT : The Official Journal of PPAG. 2012;17(3):211–9.  https://doi.org/10.5863/1551-6776-17.3.211.CrossRefGoogle Scholar
  14. 14.
    Hensley K, Venkova K, Christov A, Gunning W, Park J. Collapsin response mediator protein-2: an emerging pathologic feature and therapeutic target for neurodisease indications. Mol Neurobiol. 2011;43(3):180–91.  https://doi.org/10.1007/s12035-011-8166-4.CrossRefGoogle Scholar
  15. 15.
    Krauss GL, Edwards HB, Lin B. Lacosamide for the treatment of epilepsy. Ann Med. 2012;44(7):674–9.  https://doi.org/10.3109/07853890.2011.603700.CrossRefGoogle Scholar
  16. 16.
    Cherry S, Judd L, Muniz JC, Elzawahry H, LaRoche S. Safety and efficacy of lacosamide in the intensive care unit. Neurocrit Care. 2012;16(2):294–8.  https://doi.org/10.1007/s12028-011-9662-0.CrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology 2019

Authors and Affiliations

  • John Teijido
    • 1
    Email author
  • Derek Kempf
    • 2
  • Elizabeth Laubach
    • 3
  • Amy Zosel
    • 1
    • 4
  • Douglas Borys
    • 2
    • 4
  1. 1.Medical College of WisconsinMilwaukeeUSA
  2. 2.Concordia University of Wisconsin, School of PharmacyMequonUSA
  3. 3.Ascension Columbia St. Mary’s Hospital OzaukeeThiensvilleUSA
  4. 4.Wisconsin Poison Center, Children’s Hospital of WisconsinMilwaukeeUSA

Personalised recommendations