lacosamide
Vimpat (lacosamide) is an antiepileptic (anti-seizure) medication. It can be taken on its own or with other antiepileptics to treat partial-onset seizures (also known as focal seizures). It's also an add-on therapy to treat primary generalized tonic-clonic (PGTC) seizures (also known as grand mal seizures). The dosage is adjusted based on how well it works and whether you're having any side effects. Vimpat (lacosamide) is available in both brand-name and generic versions. It's classified as a schedule V controlled substance.
What is Vimpat (lacosamide)?
What is Vimpat (lacosamide) used for?
Treatment for partial-onset seizures - for people at least 1 month of age (Vimpat brand) or at least 4 years old (generic)
Add-on treatment for primary generalized tonic-clonic (PGTC) seizures - for people at least 4 years old (Vimpat brand only)
How Vimpat (lacosamide) works
Vimpat (lacosamide) is an antiepileptic. While it's not exactly clear how the medication works to treat seizures, it's thought to slow the activity of sodium channels in the brain. This helps to calm your brain activity to control seizures.
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What are the risks and warnings for Vimpat (lacosamide)?
Vimpat (lacosamide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts and behavior
Antiepileptic (anti-seizure) medications like Vimpat (lacosamide) can raise your risk of suicide or thoughts of suicide. Watch for any new or worsening depression and any unusual changes in mood or behavior, especially during the first few months of taking this medication or when your dose changes. Report anything concerning to your provider. If you have thoughts of hurting yourself, call 911 or get medical attention right away.
Dizziness and difficulty controlling movements
Risk factors: Taking higher doses of Vimpat (lacosamide)
Vimpat (lacosamide) can make you feel dizzy or have problems with movement or coordination. This usually happens when you first start the medication or when you switch to a higher dose. Talk to your provider if this side effect doesn't go away or if it's too bothersome.
Abnormal heartbeat
Risk factors: History of abnormal heartbeat | Taking other medications that affect heartbeat | Heart disease such as heart attack or heart failure | Nerve damage due to high blood sugar (diabetes)
Vimpat (lacosamide) can affect the electrical activity in the heart and cause abnormal heartbeat, which can rarely be life-threatening. This is more likely to happen if you already have heart problems to begin with. Make sure to tell your provider and pharmacist about all the other medications that you take, so they can watch out for potentially dangerous interactions. If necessary, your provider might check your heart's electrical activity through a test called an electrocardiogram (EKG) before you start Vimpat (lacosamide) as well as regularly during treatment. Get medical attention if you experience chest discomfort, palpitations, or if you feel like you're going to pass out while taking Vimpat (lacosamide).
Fainting
Risk factors: Taking high doses of Vimpat (lacosamide) | Taking other medications that affect heartbeat | Heart disease such as heart attack or heart failure
In some rare cases, some people who took Vimpat (lacosamide) fainted during treatment. This is usually related to having low blood pressure when getting up too quickly or to having an abnormal heartbeat (which might happen while you're taking Vimpat (lacosamide)). Make sure to get up slowly if you've been sitting or lying down for a while. If you feel like you're going to faint or pass out, try lying down and raising your legs. This helps move your blood to your heart and help raise blood pressure. If that doesn't help, call 911 or get help right away.
Withdrawal seizures
Risk factors: Stopping Vimpat (lacosamide) suddenly
Don't stop taking Vimpat (lacosamide) without talking to your provider first. Antiepileptic (anti-seizure) medications like Vimpat (lacosamide) shouldn't be stopped too suddenly, since this can lead to seizures due to medication withdrawal. If it's necessary to stop taking it, your provider will instruct you to lower your dose slowly over at least 1 week.
Allergic reactions
In some rare cases, people have developed serious and sometimes life-threatening allergic reactions after starting Vimpat (lacosamide). This can cause abnormal blood cell counts and damage to important organs, such as your liver, kidneys, or heart. Get medical help right away if you notice a rash; fever; swollen lymph nodes; flu-like symptoms; or swelling of the mouth, face, or throat.
Caution if you have PKU (oral solution form only)
The oral solution form of Vimpat (lacosamide) contains aspartame, which can be harmful for someone with a condition called phenylketonuria (PKU). If you or your child has PKU, talk to your provider about whether it's safe to take the oral solution form of this medication.
What are the side effects of Vimpat (lacosamide)?
Common Side Effects
- Dizziness (up to 31%)
- Headache (up to 13%)
- Nausea (up to 11%)
- Double vision (up to 11%)
- Vomiting (up to 9%)
- Fatigue (up to 9%)
- Blurred vision (up to 8%)
- Difficulty with movement or coordination (up to 8%)
- Sleepiness (up to 7%)
Other Side Effects
- Feeling like the room is spinning
- Difficulty walking
- Difficulty with balance
- Difficulty with memory
- Tremor
- Shaky eye movements
- Diarrhea
- Depression
- Itching
- Bruise
Serious Side Effects
- Thoughts of hurting yourself or suicide
- Excessive drowsiness
- Abnormal heartbeat: chest discomfort, palpitations, feeling like you're going to pass out
- Severe allergic reaction: rash; fever; swollen lymph nodes; flu-like symptoms; swelling of the mouth, face, or throat; dark urine; yellowing of the skin or whites of the eyes
Source: DailyMed
More on Vimpat (lacosamide) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Rash, fever, and swollen lymph nodes
- Thoughts of suicide or self-harm, worsening mood, or feelings of depression
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Dizziness
- Double vision
- Drowsiness
- Headache
- Loss of balance or coordination
- Nausea
Pros and cons of Vimpat (lacosamide)
Pros
Can take the medication on its own for partial-onset seizures (also called focal seizures)
Can take with other seizure medications
Available as a tablet and oral solution (and an injection form if you're in the hospital)
Can give to children 1 month of age and older
Cons
Shouldn't be the only medication you take for primary generalized tonic-clonic (PGTC) seizures
Is a controlled medication, so you can only get a limited amount per month
Interacts with many medications, such as beta blockers
Can cause side effects like dizziness, headache, and nausea
Pharmacist tips for Vimpat (lacosamide)
You can take Vimpat (lacosamide) with or without food. Food doesn't affect how well this medication works.
Vimpat (lacosamide) can make you feel dizzy, sleepy, or have blurry vision. This can happen particularly when you first start taking the medication or after you switch to a higher dose. Be careful driving or doing anything requiring concentration until you know how this medication affects you.
Don't stop taking Vimpat (lacosamide) without talking to your provider first. Stopping it too suddenly can cause seizures due to withdrawal.
Let your provider know if you plan to breastfeed while you're taking Vimpat (lacosamide) so they can discuss the risks and benefits with you. The medication can pass into breast milk, and it's possible that breastfed babies can have side effects like sleepiness.
Tips for the Vimpat (lacosamide) oral solution
The Vimpat (lacosamide) oral solution is good for 6 months after you open the bottle. Ask your pharmacist how to safely throw out expired or unused medication.
Ask your pharmacist for a measuring device to measure out your dose. Don't use a household teaspoon or tablespoon because they might not give you the correct dose.
Frequently asked questions about Vimpat (lacosamide)
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Vimpat (lacosamide) dosage forms
Typical dosing for Vimpat (lacosamide)
Adults ages 17 years and older
Partial-onset seizures (when taken by itself): The typical starting dose is 100 mg by mouth twice daily. Your provider will adjust your dose each week if necessary. The maximum dose is 200 mg twice daily.
Add-on therapy for partial-onset or primary generalized tonic-clonic (PGTC) seizures: The typical starting dose is 50 mg by mouth twice daily. Your provider will adjust your dose every week if necessary. The maximum dose is 200 mg twice daily.
Children ages 1 month to 17 years old: Dosing is based on your child's body weight. Your child's provider will adjust the dose each week if necessary.
110 lbs (50 kg) or more: The starting dose is 50 mg by mouth twice daily. The maximum dose is 200 mg twice daily.
66 lbs to less than 110 lbs (30 kg to 50 kg): The starting dose is 1 mg/kg of body weight by mouth twice daily. The maximum dose is 4 mg/kg twice daily.
24 lbs to less than 66 lbs (11 kg to 30 kg): The starting dose is 1 mg/kg of body weight by mouth twice daily. The maximum dose is 6 mg/kg twice daily.
13 lbs to less than 24 lbs (6 kg to 11 kg) - for partial-onset seizures only: The starting dose is 1 mg/kg of body weight by mouth twice daily. The maximum dose is 6 mg/kg twice daily.
13 lbs or less (6 kg or less) - for partial-onset seizures only: The starting dose is 1 mg/kg of body weight by mouth twice daily. The maximum dose of 7.5 mg/kg twice daily.
Your dose might differ if you have liver or severe kidney problems.
More on Vimpat (lacosamide) dosage forms
How much does Vimpat (lacosamide) cost?
What are alternatives to Vimpat (lacosamide)?
Treatment for partial-onset seizures - for people at least 1 month of age (Vimpat brand) or at least 4 years old (generic)
Add-on treatment for primary generalized tonic-clonic (PGTC) seizures - for people at least 4 years old (Vimpat brand only)
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
What is the latest news about Vimpat (lacosamide)?
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References
Best studies we foundBen-Menachem, E., et al. (2007). Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures. Epilepsia.
Camber Pharmaceuticals, Inc. (2023). Lacosamide injection [package insert]. DailyMed.
Centers for Disease Control and Prevention. (2020). Spoons are for soup, milliliters are for medicine.
Centers for Disease Control and Prevention. (2020). Types of seizures.
Doty, P., et al. (2013). Development of lacosamide for the treatment of partial-onset seizures. Annals of the New York Academy of Sciences.
Kiriakopoulos, E., et al. (n.d.). Focal onset aware seizures (simple partial seizures). Epilepsy Foundation.
Kiriakopoulos, E., et al. (n.d.). Tonic-clonic seizures. Epilepsy Foundation.
Li, J., et al. (2020). The adverse-effect profile of lacosamide. Expert Opinion on Drug Safety.
MedlinePlus. (2023). Phenylketonuria.
Procter, L. D. (2022). Low blood pressure. Merck Manual Consumer Version.
Rogawski, M., et al. (2015). Current understanding of the mechanism of action of the antiepileptic drug lacosamide. Epilepsy Research.
United Collection Bureau, Inc. (2023). Vimpat- lacosamide tablet, film coated vimpat- lacosamide injection vimpat- lacosamide solutio [package insert]. DailyMed.
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