It is possible to manage lacosamide side effects in patients through an integrated approach involving dose titration, monitoring for symptoms and patient education. Lacosamide is used as an anti-epileptic for partial-onset seizures caused by epilepsy and works on sodium channels in the brain to stabilize hyperexcitable neuronal membranes. Clinical trials show that it works, but about 30% develop side effects at least transiently; dizziness and fatigue are most frequent. As an example, dizziness was reported in almost 25% of patients on there usual doses between 200-400 mg/day and either warranted dose modification(increase or reduction). []
Titration schedules are incredibly important in managing dizziness. Advice to start patients at a 50-mg twice daily dose, then titrate up by another 50 mg/week is also used in an effort to mitigate the dizziness problem that helps account for its popularity. The slow titration enables the body to become accustomed slowly to the drug while avoiding sudden alterations in sodium channel activity, which can lead to side effects. Patients remaining quite dizzy, they tell me that if we gave them doses in the evening it is less likely to interfere with daytime activities.
The Journal of Clinical Pharmacology: Roughly 16 percent of patients have experienced fatigue01. This requires lifestyle modifications — increasing vigilance about sleep hygiene, and budgeting activities according to when you are most energetic. It can also help fatigue be less stacked on with dividing the daily dose in to smaller fractions. In patients with ongoing fatigue, examining other medications the patient may be on is critical as some drugs can potentiate this symptom.
Patients — especially during initial treatment stages, the first line of therapy and nausea/vomiting (N&V)(~10%); were also impacted by gastrointestinal symptoms such as constipation immediately after radioiodine administration. These symptoms are significantly reduced if lacosamide is taken with food, as this slows down drug absorption and stops irritation to the stomach. Anti-emetics may temporarily be used for more severe cases until the patient can better tolerate. Small and frequent meals with regular hydration can help to overcome the gastrointestinal distress.
In a small percentage of patients, likely around 5-7% do exhibit increased emotion that manifests as irritability or mood swings («BME»), referring to behavioral/mood/emotional side effects). These effects must be monitored closely, particularly with a prior history of mood disorders. Cognitive-behavioral techniques and mental health monitoring can help keep these symptoms in check. In patients with clinically relevant mood changes, it may be prudent to withdraw levetiracetam or switch to another antiepileptic drug.
Lacosamide, like other AEDs, can be associated with CV effects so let us not stop paying attention to its potential effect on the heart. By prolonging the PR interval, increasing use of this drug in a susceptible population could trigger arrhythmias. This is estimated to occur in less than 1% of patients, however as pre-existing cardiac conditions are a complete contraindication to hydroxychloroquine use, it would be best practice recommendable baseline ECG monitoring. Highlights of a 2020 study from Cardiology in Review included based on the increasing evidence, regular cardiac assessment is important for elderly as well as those having comorbid factors such as diabetes or hypertension. In case PR prolongation is significant, stopping lacosamide or reducing the dose is necessary.
A good patient station would wise to educate their patients about how well-controlled diabetes can lead a fulfilling and comfortable life. Ensuring that patients are provided with information about the potential side effects of medications and encouraged to report any new or worsening symptoms empowers early intervention. Moreover, routine follow-ups provide a continuous measure with the ability to individualize changes slope on patient response.
Mitigation of lacosamide side effects involves slowly titrating the dose upwards, treating symptoms individually and monitoring carefully. Individualised management and proactive side-effect control would enable health professionals to achieve optimal use of therapies with a minimum amount of toxicity.