Safety and Tolerability of Lacosamide in Patients With Epilepsy: A Systematic Review and Meta-Analysis

Abstract

Background: As a third-generation antiseizure medication (ASM), lacosamide (LCM) is recommended worldwide for patients with epilepsy. We aimed to provide more conclusive evidence for the safety and tolerability of LCM in patients with epilepsy.Methods: A systematic search was performed on MEDLINE, Embase, Cochrane Library, CBM, CNKI, IDB, VIP Database, and Wanfang Database from inception to 2021 March, and all studies assessing the safety of LCM were included. A meta-analysis was performed for safety data of LCM.Results: Eighty-three studies involving 12268 populations (11 randomized clinical trials (RCTs), 16 cohort studies, 53 case series, and 3 case reports) were included in our study. Meta-analysis of the total incidence of adverse events (AEs) of LCM was 38.7% [95% CI (35.1%, 45.8%); n=75 studies]. Incidence of withdrawal due to AEs was 10.8% [95% CI (9.1%, 12.6%); n=56 studies], and incidence of serious adverse events (SAEs) was 6.5% [95% CI (4.0%, 8.9%); n=13 studies]. Most AEs were in the nervous system and digestive system. The most common AEs were sedation (15.8%), dizziness (15.7%), fatigue (9.4%), and nausea/vomiting (9.3%). For children, the total incidence of AEs of LCM was 32.8% [95% CI (21.6%, 44.0%); n=16 studies], and the most common AEs were dizziness (8.6%), nausea/vomiting (8.6%), and somnolence (6.8%).Conclusion: Lacosamide is generally safe and well tolerated in patients with epilepsy. Common AEs were sedation, dizziness, and fatigue. It is necessary to pay more attention to the prevention and management of these AEs and conduct more large-scale and high-quality studies to update safety data.

Evidence for Inhibitory Perturbations on the Amplitude, Gating, and Hysteresis of A-Type Potassium Current, Produced by Lacosamide, a Functionalized Amino Acid with Anticonvulsant Properties

“…The extent to which the unwanted reactions linked to the LCS treatment was explained by its on the magnitude, gating, and V hys of I K(A) and thus warrants further investigation. Findings from the present study tend to be informative as they highlight the proof-of-concept that needs to be taken into consideration since the wide spectrum of LCS's beneficial effects has been clinically observed [1][2][3][4][5][6][7][9][10][11][12][13][14][15][16][17][18][19][20][21]24,25,32].…”

“…Lacosamide (LCS, Vimpat ® ) is regarded as a functionalized amino acid (available orally and intravenously) for the treatment of a wide variety of seizures, such as focal-onset seizure or refractory status epilepticus [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. However, of note, although LCS is safe and effective in anti-convulsant activities, the unwanted events following LCS treatment, such as dizziness, abnormal vision, diplopia, ataxia, personality changes, and cardiovascular adverse events (e.g., sinus node dysfunction), have gradually emerged [3,6,7,[18][19][20][21][22][23][24]. The risk of myoclonic seizure was also reported to occur during the treatment with this drug [25].…”

Characterization of cardiac bradyarrhythmia associated with LGI1-IgG autoimmune encephalitis

“…( 17 ) However, some sodium channel blocking medications, such as lacosamide, can cause or potentially worsen bradyarrhythmias. ( 18 , 19 ) Sodium channel blocking drugs are known to be proarrhythmic in patients with history of coronary artery disease and structural heart disease. ( 20 ) Indeed, five of our patients were taking sodium channel blockers during their bradycardia episode, therefore among these cases adverse effect of anti-seizure medications cannot be completely excluded.…”

Epilepsy in childhood: an update on management

“…Two cohort studies compared lacosamide and levetiracetam for AEs; total incidence of AEs between the two groups was significantly different [RR = 0.67; 95% CI (0.46, 0.96); p = 0.03]. For AEs involving the nervous system, there were significant differences in the incidence of sedation between the two drugs [RR = 0.21; 95% CI (0.08, 0.55); p = 0.001] [12].…”