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==Mechanism of Action and Pharmacodynamics==
==Mechanism of Action and Pharmacodynamics==
Lacosamide is a functionalized amino acid that produces activity in the maximal electroshock seizure test, like other antiepileptic drugs that are believed to act through [[Sodium channel|voltage-gated sodium channels]]. Lacosamide enhances the slow inactivation of voltage-gated sodium channels without interacting with the fast inactivation of [[Sodium channel|voltage-gated sodium channels]]. This inactivation prevents the channel from opening, and helps end the action potential. Many antiepileptic drugs, like [[carbamazepine]] or [[lamotrigine]], slow the recovery from inactivation and hence reduce the ability of neurons to fire action potentials. Inactivation only occurs in neurons firing action potentials; this means that drugs that modulate fast inactivation selectively reduce the firing in active cells. Slow inactivation is similar but does not produce complete blockade of voltage gated sodium channels, with both activation and inactivation occurring over hundreds of milliseconds or more. Lacosamide makes this inactivation happen at less depolarized [[membrane potential]]s. This means that lacosamide only affects neurons which are depolarized or active for long periods of time, typical of neurons at the focus of epilepsy.<ref name="pmid17940193">{{cite journal |author=Errington AC, Stöhr T, Heers C, Lees G |title=The investigational anticonvulsant lacosamide selectively enhances slow inactivation of voltage-gated sodium channels |journal=Molecular Pharmacology |volume=73 |issue=1 |pages=157–69 |date=January 2008 |pmid=17940193 |doi=10.1124/mol.107.039867 |url=}}</ref> Lacosamide administration results in the inhibition of repetitive neuronal firing, the stabilization of hyperexcitable neuronal membranes, and the reduction of long-term channel availability, but does not affect physiological function.<ref>{{cite journal|pmid=23859801}}</ref> Lacosamide has a dual mechanism of action. It also modulates [[Collapsin response mediator protein family|collapsin response mediator protein 2]] (CRMP-2), preventing the formation of abnormal neuronal connections in the brain.<ref>{{cite web|url=http://www.prnewswire.com/news-releases/schwarz-pharma-highlights-the-results-of-13-lacosamide-data-presentations-at-north-american-regional-epilepsy-congress-in-san-diego-55922847.html}}</ref>
Lacosamide is a functionalized amino acid that produces activity in the maximal electroshock seizure test, like other antiepileptic drugs that are believed to act through [[Sodium channel|voltage-gated sodium channels]]. Lacosamide enhances the slow inactivation of voltage-gated sodium channels without interacting with the fast inactivation of [[Sodium channel|voltage-gated sodium channels]]. This inactivation prevents the channel from opening, and helps end the action potential. Many antiepileptic drugs, like [[carbamazepine]] or [[lamotrigine]], slow the recovery from inactivation and hence reduce the ability of neurons to fire action potentials. Inactivation only occurs in neurons firing action potentials; this means that drugs that modulate fast inactivation selectively reduce the firing in active cells. Slow inactivation is similar but does not produce complete blockade of voltage gated sodium channels, with both activation and inactivation occurring over hundreds of milliseconds or more. Lacosamide makes this inactivation happen at less depolarized [[membrane potential]]s. This means that lacosamide only affects neurons which are depolarized or active for long periods of time, typical of neurons at the focus of epilepsy.<ref name="pmid17940193">{{cite journal |author=Errington AC, Stöhr T, Heers C, Lees G |title=The investigational anticonvulsant lacosamide selectively enhances slow inactivation of voltage-gated sodium channels |journal=Molecular Pharmacology |volume=73 |issue=1 |pages=157–69 |date=January 2008 |pmid=17940193 |doi=10.1124/mol.107.039867 |url=}}</ref> Lacosamide administration results in the inhibition of repetitive neuronal firing, the stabilization of hyperexcitable neuronal membranes, and the reduction of long-term channel availability, but does not affect physiological function.<ref>{{cite journal|last=Doty|first=P|coauthors=Hebert D, Mathy FX, Byrnes W, Zackheim J, Simontacchi K|title=Development of lacosamide for the treatment of partial-onset seizures|journal=Ann N Y Acad Sci|date=2013|volume=1291|pages=56-68|doi=10.1111/nyas.12213|pmid=23859801}}</ref> Lacosamide has a dual mechanism of action. It also modulates [[Collapsin response mediator protein family|collapsin response mediator protein 2]] (CRMP-2), preventing the formation of abnormal neuronal connections in the brain.<ref>{{cite news|title=SCHWARZ PHARMA Highlights the Results of 13 Lacosamide Data Presentations at North American Regional Epilepsy Congress in San Diego|url=http://www.prnewswire.com/news-releases/schwarz-pharma-highlights-the-results-of-13-lacosamide-data-presentations-at-north-american-regional-epilepsy-congress-in-san-diego-55922847.html|accessdate=2 April 2014|newspaper=Schwarz Pharma|date=5 December 1996}}</ref>


Lacosamide does not affect [[AMPA receptor|AMPA]], [[Kainate receptor|kainate]], [[NMDA receptor|NMDA]], [[GABAA receptor|GABA<sub>A</sub>]], [[GABA B receptor|GABA<sub>B</sub>]] or a variety of dopaminergic, serotonergic, adrenergic, muscarinic or cannabinoid receptors and does not block potassium or calcium currents.<ref name="pmid16620882">{{cite journal |author=Errington AC, Coyne L, Stöhr T, Selve N, Lees G |title=Seeking a mechanism of action for the novel anticonvulsant lacosamide |journal=Neuropharmacology |volume=50 |issue=8 |pages=1016–29 |date=June 2006 |pmid=16620882 |doi=10.1016/j.neuropharm.2006.02.002 |url=}}</ref> Lacosamide does not modulate the reuptake of neurotransmitters including [[norepinephrine]], [[dopamine]], and [[serotonin]].<ref>{{cite journal|pmid=17461888}}</ref> In addition, it does not inhibit GABA transaminase.<ref>{{cite journal|pmid=16620882}}</ref>
Lacosamide does not affect [[AMPA receptor|AMPA]], [[Kainate receptor|kainate]], [[NMDA receptor|NMDA]], [[GABAA receptor|GABA<sub>A</sub>]], [[GABA B receptor|GABA<sub>B</sub>]] or a variety of dopaminergic, serotonergic, adrenergic, muscarinic or cannabinoid receptors and does not block potassium or calcium currents.<ref name="pmid16620882">{{cite journal |author=Errington AC, Coyne L, Stöhr T, Selve N, Lees G |title=Seeking a mechanism of action for the novel anticonvulsant lacosamide |journal=Neuropharmacology |volume=50 |issue=8 |pages=1016–29 |date=June 2006 |pmid=16620882 |doi=10.1016/j.neuropharm.2006.02.002 |url=}}</ref> Lacosamide does not modulate the reuptake of neurotransmitters including [[norepinephrine]], [[dopamine]], and [[serotonin]].<ref>{{cite journal|last=Beyreuther|first=BK|coauthors=Freitag, J; Heers, C; Krebsfänger, N; Scharfenecker, U; Stöhr, T|title=Lacosamide: a review of preclinical properties.|journal=CNS drug reviews|date=2007 Spring|volume=13|issue=1|pages=21-42|pmid=17461888}}</ref> In addition, it does not inhibit GABA transaminase.<ref>{{cite journal|last=Errington|first=AC|coauthors=Coyne, L; Stöhr, T; Selve, N; Lees, G|title=Seeking a mechanism of action for the novel anticonvulsant lacosamide.|journal=Neuropharmacology|date=2006 Jun|volume=50|issue=8|pages=1016-29|pmid=16620882}}</ref>


==Pharmacokinetics==
==Pharmacokinetics==
When administered orally in healthy individuals, lacosamide is rapidly absorbed from the [[Human gastrointestinal tract|gastrointestinal tract]]. Little of the drug is lost via the first pass effect, and thus has an oral [[bioavailability]] of nearly 100%.<ref>{{cite journal|pmid=12789603}}</ref> In adults, lacosamide demonstrates a low plasma protein binding of <15, which reduces the potential for interaction with other drugs. Lacosamide is at its highest concentration in blood plasma approximately 1 to 4 hours after oral administration. Lacosamide has a half life of about 12-16 hours, which remains unchanged if the patients is also taking enzyme inducers. Consequently, the drug is administered twice per day at 12 hour intervals. Lacosamide is excreted renally, with 95% of the drug eliminated in the urine.<ref>{{cite journal|pmid=23640503}}</ref> 40% of the compound remained unchanged from its original structure, while the rest of the elimination product consists of metabolites of lacosamide. Just 0.5% of the drug is eliminated in the feces.<ref>{{cite web|url=http://www.drugbank.ca/drugs/DB06218}}</ref> The major metabolic pathway of lacosamide is CYP2C9, CY2C19, and CYP3A4-mediated demethylation. <ref>{{cite journal|pmid=PMC2759042}}</ref>
When administered orally in healthy individuals, lacosamide is rapidly absorbed from the [[Human gastrointestinal tract|gastrointestinal tract]]. Little of the drug is lost via the first pass effect, and thus has an oral [[bioavailability]] of nearly 100%.<ref>{{cite journal|last=Hovinga|first=CA|title=SPM-927 (Schwarz Pharma)|journal=IDrugs|date=2003|volume=6|issue=5|page=479-85|pmid=12789603|url=http://www.ncbi.nlm.nih.gov/pubmed/?term=12789603|accessdate=2 April 2014}}</ref> In adults, lacosamide demonstrates a low plasma protein binding of <15, which reduces the potential for interaction with other drugs. Lacosamide is at its highest concentration in blood plasma approximately 1 to 4 hours after oral administration. Lacosamide has a half life of about 12-16 hours, which remains unchanged if the patients is also taking enzyme inducers. Consequently, the drug is administered twice per day at 12 hour intervals. Lacosamide is excreted renally, with 95% of the drug eliminated in the urine.<ref>{{cite journal|last=Italiano|first=D|coauthors=Perucca E|title=Clinical pharmacokinetics of new-generation antiepileptic drugs at the extremes of age: an update|journal=Clin Pharmacokinet|date=2013|volume=52|issue=8|pages=627-45|doi=10.1007/s40262-013-0067-4|pmid=23640503|url=http://www.ncbi.nlm.nih.gov/pubmed/?term=23640503|accessdate=2 April 2014}}</ref> 40% of the compound remained unchanged from its original structure, while the rest of the elimination product consists of metabolites of lacosamide. Just 0.5% of the drug is eliminated in the feces.<ref>{{cite web|title=Lacosamide|url=http://www.drugbank.ca/drugs/DB06218|publisher=DrugBank|accessdate=2 April 2014}}</ref> The major metabolic pathway of lacosamide is CYP2C9, CY2C19, and CYP3A4-mediated demethylation. <ref>{{cite journal|last=Abou-Khalil|first=BW|title=Lacosamide: what can be expected from the next new antiepileptic drug?|journal=Epilepsy Curr|date=2009|volume=9|issue=5|pages=133-4|doi=10.1111/j.1535-7511.2009.01317.x|pmid=19826503|accessdate=2 April 2014}}</ref>


The [[Dose-response relationship|dose-response curve]] for lacosamide is linear and proportional for oral doses of up to 800 mg and intravenous doses of up to 300 mg.<ref>{{cite journal|journal=15570674}}</ref> Lacosamide has low potential for drug-drug interactions, and no pharmacokinetic interactions have been found to occur with other antiepileptic drugs (AEDs) that act on sodium channels.<ref>{{cite web|url=http://www.regencerx.com/docs/physicianRx/neurological-seizure-medications-04-2009.pdf}}</ref> A study on the binding of lacosamide to CRMP-2 in ''Xenopus'' oocytes showed both competitive and specific binding. Lacosamide has a K<sub>d</sub> value just under 5μM and a B<sub>max</sub> of about 200 pM/mg.<ref>{{cite web|url=http://www.google.com/patents/EP1873527A1?cl=en}}</ref> The [[volume of distribution]] (V<sub>d</sub>) of lacosamide in plasma is 0.6 L/kg, which is close to the total volume of water. Lacosamide is ampiphilic and is this hydrophilic but also lipophilic enough to cross the blood-brain barrier.<ref>{{cite journal|pmid=17433624}}</ref>
The [[Dose-response relationship|dose-response curve]] for lacosamide is linear and proportional for oral doses of up to 800 mg and intravenous doses of up to 300 mg.<ref>{{cite journal|last=Bialer|first=M|coauthors=Johannessen SI, Kupferberg HJ, Levy RH, Perucca E, Tomson T|title=Progress report on new antiepileptic drugs: a summary of the Seventh Eilat Conference (EILAT VII)|journal=Epilepsy Res|date=2004|volume=61|issue=1-3|pages=1-48|pmid=15570674|accessdate=2 April 2014}}</ref> Lacosamide has low potential for drug-drug interactions, and no pharmacokinetic interactions have been found to occur with other antiepileptic drugs (AEDs) that act on sodium channels.<ref>{{cite web|title=Therapeutic Class Review|url=http://www.regencerx.com/docs/physicianRx/neurological-seizure-medications-04-2009.pdf|publisher=RegenceRx|accessdate=2 April 2014}}</ref> A study on the binding of lacosamide to CRMP-2 in ''Xenopus'' oocytes showed both competitive and specific binding. Lacosamide has a K<sub>d</sub> value just under 5μM and a B<sub>max</sub> of about 200 pM/mg.<ref>{{cite web|title=Method for identifying CRMP modulators|url=http://www.google.com/patents/EP1873527A1?cl=en|accessdate=2 April 2014}}</ref> The [[volume of distribution]] (V<sub>d</sub>) of lacosamide in plasma is 0.6 L/kg, which is close to the total volume of water. Lacosamide is ampiphilic and is this hydrophilic but also lipophilic enough to cross the blood-brain barrier.<ref>{{cite journal|last=Stoht|first=T|coauthors=Kupferberg HJ, Stables JP, Choi D, Kohn H, Walton N, White HS|title=Lacosamide, a novel anti-convulsant drug, shows efficacy with a wide safety margin in rodent models for epilepsy|journal=Epilepsy Res|date=2007|volume=74|issue=2-3|pages=147-54|pmid=17433624|url=http://www.ncbi.nlm.nih.gov/pubmed/?term=17433624|accessdate=2 April 2014}}</ref>


===Dosage===
===Dosage===
Lacosamide is initially prescribed in oral doses of 50 mg twice daily, with a total dose of 100 mg/day.The dosing can be increased by 100 mg/day following a twice-daily dose up to a total dose of 200-400 mg/day. Clinical trials showed that a dose of 600 mg/day was not note effective than a dose of 400 mg/day, but resulted in more adverse reactions. Lacosamide is administered orally through film-coated tablets of 50 mg (pink), 100 mg (dark yellow), 150 mg (salmon), and 200 mg (blue). It can also be administered by injection at a concentration of 200 mg/20 mL or by oral solution at a concentration of 10 mg/mL.<ref>{{cite web|url=http://www.vimpat.com/pdf/pi.pdf}}</ref>
Lacosamide is initially prescribed in oral doses of 50 mg twice daily, with a total dose of 100 mg/day.The dosing can be increased by 100 mg/day following a twice-daily dose up to a total dose of 200-400 mg/day. Clinical trials showed that a dose of 600 mg/day was not note effective than a dose of 400 mg/day, but resulted in more adverse reactions. Lacosamide is administered orally through film-coated tablets of 50 mg (pink), 100 mg (dark yellow), 150 mg (salmon), and 200 mg (blue). It can also be administered by injection at a concentration of 200 mg/20 mL or by oral solution at a concentration of 10 mg/mL.<ref>{{cite web|title=Highlights of Prescribing Information|url=http://www.vimpat.com/pdf/pi.pdf|publisher=Vimpat|accessdate=2 April 2014}}</ref>


==Preclinical trials==
==Preclinical trials==
In preclinical trials, the effect of lacosamide administration on animal models of epilepsy was tested using the Frings audiogenic seizures (AGS)-susceptible mouse model of seizure activity with an [[Effective dose (pharmacology)|effective dose]] (ED<sub>50</sub>) of 0.63 mg/kg, i.p.<ref>{{cite journal|pmid=17461888}}</ref> The effect of lacosamide was also assessed using the maximal electroshock (MES) test to detect inhibition of seizure spread.<ref>{{cite journal|pmid=9105875}}</ref> <ref>{{cite journal|pmid=13000628}}</ref> Lacosamide administration was successful in preventing the spread of seizures induced by MES in mice (ED<sub>50</sub> = 4.5 mg/kg, i.p.) and rate (ED<sub>50</sub> = 3.9 mg/kg, p.o.).<ref>{{cite journal|pmid=17461888}}</ref> In preclinical trials, administration of lacosamide in combination with other AEDs resulted in synergistic anticonvulsant effects. Lacosamide produced effects in animal models for essential tremor, tardive dyskinesia schizophrenia, and [[anxiety]].<ref>{{cite news|url=http://www.prnewswire.com/news-releases/schwarz-pharma-highlights-the-results-of-13-lacosamide-data-presentations-at-north-american-regional-epilepsy-congress-in-san-diego-55922847.html}}</ref> Preclinical trials found the S-stereoisomer to be less potent than the R-stereoisomer in the treatment of seizures.<ref>{{cite journal|pmid=11557357}}</ref>
In preclinical trials, the effect of lacosamide administration on animal models of epilepsy was tested using the Frings audiogenic seizures (AGS)-susceptible mouse model of seizure activity with an [[Effective dose (pharmacology)|effective dose]] (ED<sub>50</sub>) of 0.63 mg/kg, i.p.<ref>{{cite journal|last=Beyreuther|first=BK|coauthors=Freitag J, Heers C, Krebsfanger N, Scharfenecker U, Stohr T|title=Lacosamide: a review of preclinical properties|journal=CNS Drug Rev|date=2007|volume=13|issue=1|pages=21-42|pmid=17461888|url=http://www.ncbi.nlm.nih.gov/pubmed/?term=17461888|accessdate=2 April 2014}}</ref> The effect of lacosamide was also assessed using the maximal electroshock (MES) test to detect inhibition of seizure spread.<ref>{{cite journal|last=Borowicz|first=KK|coauthors=Gaisor M, Kleinrok Z, Czuczwar SJ|title=Influence of isradipine, niguldipine and dantrolene on the anticonvulsive action of conventional antiepileptics in mice|journal=Eur J Pharmacol|date=1997|volume=323|issue=1|pages=45-51|pmid=9105875|url=http://www.ncbi.nlm.nih.gov/pubmed/?term=9105875|accessdate=2 April 2014}}</ref> <ref>{{cite journal|last=Swinyard|first=EA|coauthors=Brown WC, Godman LS|title=Comparative assays of antiepileptic drugs in mice and rats|journal=J Pharmacol Exp Ther|date=1952|volume=106|issue=3|pages=319-20|pmid=13000628|accessdate=2 April 2014}}</ref> Lacosamide administration was successful in preventing the spread of seizures induced by MES in mice (ED<sub>50</sub> = 4.5 mg/kg, i.p.) and rate (ED<sub>50</sub> = 3.9 mg/kg, p.o.).<ref>{{cite journal|last=Beyreuther|first=BK|coauthors=Freitag J, Heers C, Krebsfanger N, Scharfenecker U, Stohr T|title=Lacosamide: a review of preclinical properties|journal=CNS Drug Rev|date=2007|volume=13|issue=1|pages=21-42|pmid=17461888|url=http://www.ncbi.nlm.nih.gov/pubmed/?term=17461888|accessdate=2 April 2014}}</ref> In preclinical trials, administration of lacosamide in combination with other AEDs resulted in synergistic anticonvulsant effects. Lacosamide produced effects in animal models for essential tremor, tardive dyskinesia schizophrenia, and [[anxiety]].<ref>{{cite news|title=SCHWARZ PHARMA Highlights the Results of 13 Lacosamide Data Presentations at North American Regional Epilepsy Congress in San Diego|url=http://www.prnewswire.com/news-releases/schwarz-pharma-highlights-the-results-of-13-lacosamide-data-presentations-at-north-american-regional-epilepsy-congress-in-san-diego-55922847.htm|accessdate=2 April 2014|newspaper=Schwarz Pharma|date=5 December 2006}}</ref> Preclinical trials found the S-stereoisomer to be less potent than the R-stereoisomer in the treatment of seizures.<ref>{{cite journal|last=LeTiran|first=A|coauthors=Stables, JP; Kohn, H|title=Functionalized amino acid anticonvulsants: synthesis and pharmacological evaluation of conformationally restricted analogues.|journal=Bioorganic & medicinal chemistry|date=2001 Oct|volume=9|issue=10|pages=2693-708|pmid=11557357}}</ref>


==Clinical trials==
==Clinical trials==
Lacosamide was tested in three placebo-controlled, [[double-blind]], [[Randomized controlled trial|randomized]] trials of at least 1300 patients.<ref>{{cite journal|pmid=23859801}}</ref> In a multi center, multinational, placebo-controlled, double-blind, randomized clinical trial to determine the efficacy and safety of different doses of lacosamide on individuals with poorly controlled partial-onset seizures, lacosamide was found to [[statistical significance|significantly]] reduce seizure frequency when given in addition to other antiepileptics, at doses of 400 and 600&nbsp;milligrams a day.<ref name=Ben-Menachem>{{cite journal |author=Ben-Menachem E, Biton V, Jatuzis D, Abou-Khalil B, Doty P, Rudd GD |title=Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures |journal=Epilepsia |volume=48 |issue=7 |pages=1308–17 |year=2007 |pmid=17635557 |doi=10.1111/j.1528-1167.2007.01188.x}}</ref> In a smaller trial of people with [[diabetic neuropathy]], lacosamide also provided significantly better [[Pain management|pain relief]] when compared to [[placebo]].<ref name=Rauck>{{cite journal |author=Rauck RL, Shaibani A, Biton V, Simpson J, Koch B |title=Lacosamide in painful diabetic peripheral neuropathy: a phase 2 double-blind placebo-controlled study |journal=Clin J Pain |volume=23 |issue=2 |pages=150–8 |year=2007 |pmid=17237664 |doi=10.1097/01.ajp.0000210957.39621.b2}}</ref> Lacosamide administration in combination with 1-3 other AEDs was well-tolerated in patients. Lacosamide administered at 400 mg/day was found to significantly reduce pain in patients with diabetic neuropathy in a multi center, double-blind, placebo-controlled Phase III trial with a treatment duration of 18 weeks.<ref>{{cite news|url=http://www.prnewswire.com/news-releases/schwarz-pharma-highlights-the-results-of-13-lacosamide-data-presentations-at-north-american-regional-epilepsy-congress-in-san-diego-55922847.html}}</ref>
Lacosamide was tested in three placebo-controlled, [[double-blind]], [[Randomized controlled trial|randomized]] trials of at least 1300 patients.<ref>{{cite journal|last=Doty|first=P|coauthors=Hebert, D; Mathy, FX; Byrnes, W; Zackheim, J; Simontacchi, K|title=Development of lacosamide for the treatment of partial-onset seizures.|journal=Annals of the New York Academy of Sciences|date=2013 Jul|volume=1291|pages=56-68|pmid=23859801}}</ref> In a multi center, multinational, placebo-controlled, double-blind, randomized clinical trial to determine the efficacy and safety of different doses of lacosamide on individuals with poorly controlled partial-onset seizures, lacosamide was found to [[statistical significance|significantly]] reduce seizure frequency when given in addition to other antiepileptics, at doses of 400 and 600&nbsp;milligrams a day.<ref name=Ben-Menachem>{{cite journal |author=Ben-Menachem E, Biton V, Jatuzis D, Abou-Khalil B, Doty P, Rudd GD |title=Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures |journal=Epilepsia |volume=48 |issue=7 |pages=1308–17 |year=2007 |pmid=17635557 |doi=10.1111/j.1528-1167.2007.01188.x}}</ref> In a smaller trial of people with [[diabetic neuropathy]], lacosamide also provided significantly better [[Pain management|pain relief]] when compared to [[placebo]].<ref name=Rauck>{{cite journal |author=Rauck RL, Shaibani A, Biton V, Simpson J, Koch B |title=Lacosamide in painful diabetic peripheral neuropathy: a phase 2 double-blind placebo-controlled study |journal=Clin J Pain |volume=23 |issue=2 |pages=150–8 |year=2007 |pmid=17237664 |doi=10.1097/01.ajp.0000210957.39621.b2}}</ref> Lacosamide administration in combination with 1-3 other AEDs was well-tolerated in patients. Lacosamide administered at 400 mg/day was found to significantly reduce pain in patients with diabetic neuropathy in a multi center, double-blind, placebo-controlled Phase III trial with a treatment duration of 18 weeks.<ref>{{cite news|title=SCHWARZ PHARMA Highlights the Results of 13 Lacosamide Data Presentations at North American Regional Epilepsy Congress in San Diego|url=http://www.prnewswire.com/news-releases/schwarz-pharma-highlights-the-results-of-13-lacosamide-data-presentations-at-north-american-regional-epilepsy-congress-in-san-diego-55922847.html|accessdate=2 April 2014|newspaper=Schwarz Pharma}}</ref>


==Treatment==
==Treatment==
Lacosamide is an anticonvulsant compound approved for the adjunctive treatment of partial-onset seizures and neuropathic pain. Clinical trials are currently underway for the use of lacosamide as mono therapy for [[Partial seizure|partial onset seizures]].<ref>{{cite journal|pmid=23859801}}</ref> There is no evidence that lacosamide provides additional value over current AEDs for the treatment of partial-onset seizures, but it may offer a safety advantage.<ref>{{cite web|url=http://www.regencerx.com/docs/physicianRx/neurological-seizure-medications-04-2009.pdf}}</ref> Newer AEDs, including lacosamide, [[vigabatrin]], [[felbamate]], [[gabapentin]], [[tiagabine]], and rifinamide have been found to be more tolerable and safer than older drugs such as [[carbamazepine]], [[phenytoin]], and [[valproate]].<ref>{{cite web|url=http://www.medscape.com/viewarticle/747276}}</ref>
Lacosamide is an anticonvulsant compound approved for the adjunctive treatment of partial-onset seizures and neuropathic pain. Clinical trials are currently underway for the use of lacosamide as mono therapy for [[Partial seizure|partial onset seizures]].<ref>{{cite journal|last=Doty|first=P|coauthors=Hebert, D; Mathy, FX; Byrnes, W; Zackheim, J; Simontacchi, K|title=Development of lacosamide for the treatment of partial-onset seizures.|journal=Annals of the New York Academy of Sciences|date=2013 Jul|volume=1291|pages=56-68|pmid=23859801}}</ref> There is no evidence that lacosamide provides additional value over current AEDs for the treatment of partial-onset seizures, but it may offer a safety advantage.<ref>{{cite web|title=Therapeutic Class Review|url=http://www.regencerx.com/docs/physicianRx/neurological-seizure-medications-04-2009.pdf|publisher=RegenceRx|accessdate=2 April 2014}}</ref> Newer AEDs, including lacosamide, [[vigabatrin]], [[felbamate]], [[gabapentin]], [[tiagabine]], and rifinamide have been found to be more tolerable and safer than older drugs such as [[carbamazepine]], [[phenytoin]], and [[valproate]].<ref>{{cite web|title=Antiepileptic drugs|url=http://www.medscape.com/viewarticle/747276|accessdate=2 April 2014}}</ref>


==Side-effects and tolerability==
==Side-effects and tolerability==
Lacosamide was generally well tolerated in adult patients with partial-onset seizures.<ref name="lacosa">Cross SA, Curran MP.[http://adisonline.com/drugs/abstract/2009/69040/Lacosamide__In_Partial_Onset_Seizures.5.aspx].Drugs 2009;69(4):449-459. {{doi|10.2165/00003495-200969040-00005}}.</ref>
Lacosamide was generally well tolerated in adult patients with partial-onset seizures.<ref name="lacosa">Cross SA, Curran MP.[http://adisonline.com/drugs/abstract/2009/69040/Lacosamide__In_Partial_Onset_Seizures.5.aspx].Drugs 2009;69(4):449-459. {{doi|10.2165/00003495-200969040-00005}}.</ref>
The side-effects most commonly leading to discontinuation were dizziness, ataxia, vomiting, diplopia (double vision), nausea, vertigo, and blurred vision. These adverse reactions were observed in at least 10% of patients.<ref>{{cite web|url=http://www.vimpat.com/pdf/pi.pdf}}</ref> Less common side-effects include forgetfulness, discouragement, feelings of sadness, and lack of appetite.
The side-effects most commonly leading to discontinuation were dizziness, ataxia, vomiting, diplopia (double vision), nausea, vertigo, and blurred vision. These adverse reactions were observed in at least 10% of patients.<ref>{{cite web|title=Highlights of Prescribing Information|url=http://www.vimpat.com/pdf/pi.pdf|publisher=Vimpat|accessdate=2 April 2014}}</ref> Less common side-effects include forgetfulness, discouragement, feelings of sadness, and lack of appetite.


===Gastrointestinal===
===Gastrointestinal===
Line 112: Line 112:


===Allergies===
===Allergies===
Itching, rash<ref> Vimpat Side Effects Center http://www.rxlist.com/vimpat-side-effects-drug-center.htm</ref>, [[pruritus]]
Itching, rash<ref> Vimpat Side Effects Center http://www.rxlist.com/vimpat-side-effects-drug-center.html</ref>, [[pruritus]]


===Warnings===
===Warnings===
Suicidal behavior and ideation have been observed as early as one week after starting treatment with lacosamide, and is an adverse reaction from use of most AEDs. In clinical trials with a medial treatment duration of 12 weeks, the incidence of suicidal ideation was 0.43% among 27,863 patients as opposed to 0.24% among 16,029 placebo-treated patients. Suicidal behavior was observed in 1 of every 530 patients treated.<ref>{{cite web|url=http://www.vimpat.com/pdf/pi.pdf}}</ref>
Suicidal behavior and ideation have been observed as early as one week after starting treatment with lacosamide, and is an adverse reaction from use of most AEDs. In clinical trials with a medial treatment duration of 12 weeks, the incidence of suicidal ideation was 0.43% among 27,863 patients as opposed to 0.24% among 16,029 placebo-treated patients. Suicidal behavior was observed in 1 of every 530 patients treated.<ref>{{cite web|title=Highlights of Prescribing Information|url=http://www.vimpat.com/pdf/pi.pdf|publisher=Vimpat|accessdate=2 April 2014}}</ref>>


===In Pregnancy===
===In Pregnancy===
In a study conducted to asses the teratogenic potential of AEDs in the zebrafish embryo, the teratogenicity index of lacosamide was found to be higher than that of lamotigrine, [[levetiracetam]], and [[ethosuximide]]. Lacosamide administration resulted in different malformations in the neonatal zebrafish depending on dosage.<ref>{{cite journal|pmid=PMC3845484}}</ref>
In a study conducted to asses the teratogenic potential of AEDs in the zebrafish embryo, the teratogenicity index of lacosamide was found to be higher than that of lamotigrine, [[levetiracetam]], and [[ethosuximide]]. Lacosamide administration resulted in different malformations in the neonatal zebrafish depending on dosage.<ref>{{cite journal|last=Lee|first=SH|coauthors=Kang, JW; Lin, T; Lee, JE; Jin, DI|title=Teratogenic potential of antiepileptic drugs in the zebrafish model.|journal=BioMed research international|date=2013|volume=2013|pages=726478|doi=10.1155/2013/726478|pmid=24324971}}</ref>


The FDA has assigned lacosamide to pregnancy category C. Animal studies have reported incidences of fetal mortality and growth deficit. Lacosamide has not been tested during human pregnancy, and should be administered with caution. In addition, it has not been determined whether the excretion of lacosamide occurs in breast milk.<ref>{{cite web|url=http://www.drugs.com/pregnancy/lacosamide.html}}</ref>
The FDA has assigned lacosamide to pregnancy category C. Animal studies have reported incidences of fetal mortality and growth deficit. Lacosamide has not been tested during human pregnancy, and should be administered with caution. In addition, it has not been determined whether the excretion of lacosamide occurs in breast milk.<ref>{{cite web|title=Lacosamide Pregnancy and Breastfeeding Warnings|url=http://www.drugs.com/pregnancy/lacosamide.html|publisher=Drugs.com|accessdate=2 April 2014}}</ref>


===Off-label use===
===Off-label use===
Lacosamide may have a variety of off-linel uses, including for pain management and treatment of mental health disorders. Lacosamide and other AEDs have been used off-label in the management of [[bipolar disorder]], cocaine addiction, [[dementia]], [[Depression (mood)|depression]], [[Diabetic neuropathy|diabetic peripheral neuropathy]], [[fibromyalgia]], [[headache]], [[hiccoughs]], [[Huntington's disease]], [[mania]], [[migraine]], [[obsessive-compulsive disorder]], [[panic disorder]], [[restless leg syndrome]], and [[tinnitus]]. Combinations of AEDs are often employed for seizure reduction. Studies are underway for the use of lacosamide as a mono therapy for partial onset seizures, diabetic neuropathy, and fibromyalgia.<ref>{{cite web|url=http://www.regencerx.com/docs/physicianRx/neurological-seizure-medications-04-2009.pdf}}</ref>
Lacosamide may have a variety of off-linel uses, including for pain management and treatment of mental health disorders. Lacosamide and other AEDs have been used off-label in the management of [[bipolar disorder]], cocaine addiction, [[dementia]], [[Depression (mood)|depression]], [[Diabetic neuropathy|diabetic peripheral neuropathy]], [[fibromyalgia]], [[headache]], [[hiccoughs]], [[Huntington's disease]], [[mania]], [[migraine]], [[obsessive-compulsive disorder]], [[panic disorder]], [[restless leg syndrome]], and [[tinnitus]]. Combinations of AEDs are often employed for seizure reduction. Studies are underway for the use of lacosamide as a mono therapy for partial onset seizures, diabetic neuropathy, and fibromyalgia.<ref>{{cite web|title=Therapeutic Class Review|url=http://www.regencerx.com/docs/physicianRx/neurological-seizure-medications-04-2009.pdf|publisher=RegenceRx|accessdate=2 April 2014}}</ref>


AEDs are often used in the treatment of hepatic and renal disease. Lacosamide falls into a category of drugs that are at risk of being extracted by hemodialysis.<ref>{{cite journal|pmid=24365310}}</ref>
AEDs are often used in the treatment of hepatic and renal disease. Lacosamide falls into a category of drugs that are at risk of being extracted by hemodialysis.<ref>{{cite journal|last=Asconapé|first=JJ|title=Use of antiepileptic drugs in hepatic and renal disease.|journal=Handbook of clinical neurology|date=2014|volume=119|pages=417-32|doi=10.1016/B978-0-7020-4086-3.00027-8|pmid=24365310|accessdate=2 April 2014}}</ref>


==Chemistry==
==Chemistry==
Lacosamide is a powdery, white to light yellow crystalline compound. The chemical name of lacosamide is (R)-2-acetamido-N-benzyl-3-methoxypropionamide and the systemic name is N2-Acetyl-N-benzyl-O-methyl-D-serinamide.<ref>{{cite journal|pmid=17461888}}</ref> <ref>{{cite web|url=http://www.chemspider.com/Chemical-Structure.189902.html}}</ref> Lacosamide is a functional amino acid molecule that has high solubility in water and DMSO, with a solubility of 20.1 mg/mL in phosphate-buffered saline (PBS, pH 7.5, 25°C).<ref>{{cite journal|pmid=17461888}}</ref> <ref>{{cite journal|pmid=17888078}}</ref> The molecule has six rotatable bonds and one aromatic ring. Lacosamide melts at 143-144°C and boils at 536.447°C at a pressure of 760 mmHg.<ref>{{cite web|url=http://www.drugbank.ca/drugs/DB06218}}</ref> <ref>{{cite journal|pmid=PMC2754090}}</ref>
Lacosamide is a powdery, white to light yellow crystalline compound. The chemical name of lacosamide is (R)-2-acetamido-N-benzyl-3-methoxypropionamide and the systemic name is N2-Acetyl-N-benzyl-O-methyl-D-serinamide.<ref>{{cite journal|last=Beyreuther|first=BK|coauthors=Freitag, J; Heers, C; Krebsfänger, N; Scharfenecker, U; Stöhr, T|title=Lacosamide: a review of preclinical properties.|journal=CNS drug reviews|date=2007 Spring|volume=13|issue=1|pages=21-42|pmid=17461888}}</ref> <ref>{{cite web|title=Lacosamide|url=http://www.chemspider.com/Chemical-Structure.189902.html|publisher=ChemSpider|accessdate=2 April 2014}}</ref> Lacosamide is a functional amino acid molecule that has high solubility in water and DMSO, with a solubility of 20.1 mg/mL in phosphate-buffered saline (PBS, pH 7.5, 25°C).<ref>{{cite journal|last=Beyreuther|first=BK|coauthors=Freitag, J; Heers, C; Krebsfänger, N; Scharfenecker, U; Stöhr, T|title=Lacosamide: a review of preclinical properties.|journal=CNS drug reviews|date=2007 Spring|volume=13|issue=1|pages=21-42|pmid=17461888}}</ref> <ref>{{cite journal|last=Biton|first=V|coauthors=Rosenfeld, WE; Whitesides, J; Fountain, NB; Vaiciene, N; Rudd, GD|title=Intravenous lacosamide as replacement for oral lacosamide in patients with partial-onset seizures.|journal=Epilepsia|date=2008 Mar|volume=49|issue=3|pages=418-24|pmid=17888078}}</ref> The molecule has six rotatable bonds and one aromatic ring. Lacosamide melts at 143-144°C and boils at 536.447°C at a pressure of 760 mmHg.<ref>{{cite web|title=Lacosamide|url=http://www.drugbank.ca/drugs/DB06218{{!}}publisher=DrugBank|accessdate=2 April 2014}}</ref> <ref>{{cite journal|last=Kellinghaus|first=C|title=Lacosamide as treatment for partial epilepsy: mechanisms of action, pharmacology, effects, and safety.|journal=Therapeutics and clinical risk management|date=2009|volume=5|pages=757-66|pmid=19816574}}</ref>


===Synthesis===
===Synthesis===
Line 135: Line 135:
[[File:Synthesis of Lacosamide.jpg|500pm]]
[[File:Synthesis of Lacosamide.jpg|500pm]]


(R)-2-amino-3-hydroxypropanoic acid is treated with [[acetic anhydride]] and [[acetic acid]]. The product is treated first with N-methylmorpholine, isobutyl chloroformate, and [[benzylamine]], next with [[methyl iodide]] and [[silver oxide]], forming lacosamide.<ref>{{cite journal|pmid=8627614}}</ref>
(R)-2-amino-3-hydroxypropanoic acid is treated with [[acetic anhydride]] and [[acetic acid]]. The product is treated first with N-methylmorpholine, isobutyl chloroformate, and [[benzylamine]], next with [[methyl iodide]] and [[silver oxide]], forming lacosamide.<ref>{{cite journal|last=Choi|first=D|coauthors=Stables, JP; Kohn, H|title=Synthesis and anticonvulsant activities of N-Benzyl-2-acetamidopropionamide derivatives.|journal=Journal of medicinal chemistry|date=1996 Apr 26|volume=39|issue=9|pages=1907-16|pmid=8627614}}</ref>


More efficient routes to synthesis have been proposed in recent years, including the following.<ref>{{cite journal|pmid=PMC2701728}}</ref> <ref>{{cite journal|last=McIntyre|first=J.A.|coauthors=Castaner, J|title=2004|journal=Drugs Future|volume=29|issue=992}}</ref>
More efficient routes to synthesis have been proposed in recent years, including the following.<ref>{{cite journal|last=Morieux|first=P|coauthors=Stables, JP; Kohn, H|title=Synthesis and anticonvulsant activities of N-benzyl (2R)-2-acetamido-3-oxysubstituted propionamide derivatives.|journal=Bioorganic & medicinal chemistry|date=2008 Oct 1|volume=16|issue=19|pages=8968-75|pmid=18789868}}</ref> <ref>{{cite journal|last=McIntyre|first=J.A.|coauthors=Castaner, J|title=2004|journal=Drugs Future|volume=29|issue=992}}</ref>


[[File:Lacosamide.png|500px]]
[[File:Lacosamide.png|500px]]

Revision as of 13:31, 2 April 2014

Lacosamide
Clinical data
Trade namesVimpat
Other names(2R)-2-(acetylamino)-N-benzyl-3-methoxypropanamide
AHFS/Drugs.comMonograph
MedlinePlusa609028
Pregnancy
category
  • C
Routes of
administration		Oral, intravenous
ATC code
Legal status
Legal status
  • Schedule V (U.S.)
Pharmacokinetic data
BioavailabilityHigh
Elimination half-life13 hours
ExcretionRenal
Identifiers
  • N2-acetyl-N-benzyl-D-homoserinamide
CAS Number
PubChem CID
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.112.805 Edit this at Wikidata
Chemical and physical data
FormulaC13H18N2O3
Molar mass250.294 g/mol g·mol−1
3D model (JSmol)
  • O=C(N[C@@H](C(=O)NCc1ccccc1)COC)C
  • InChI=1S/C13H18N2O3/c1-10(16)15-12(9-18-2)13(17)14-8-11-6-4-3-5-7-11/h3-7,12H,8-9H2,1-2H3,(H,14,17)(H,15,16)/t12-/m1/s1 checkY
  • Key:VPPJLAIAVCUEMN-GFCCVEGCSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Lacosamide (INN, formerly known as erlosamide, harkeroside, SPM 927, or ADD 234037) is a medication developed by Union Chimique Belge (UCB) for the adjunctive treatment of partial-onset seizures and diabetic neuropathic pain marketed under the trade name Vimpat.

The U.S. Food and Drug Administration (FDA) accepted UCB's New Drug Application for lacosamide as of November 29, 2007, beginning the approval process for the drug.[1][2] UCB also filed for marketing approval in the European Union (EU); the European Medicines Agency accepted the marketing application for review in May 2007.[1][3]

The drug was approved in the EU on September 3, 2008.[4] It was approved in the US on October 29, 2008.[5] Lacosamide release was delayed owing to an objection about its placement into schedule V of the Controlled Substances Act. The FDA issued their final rule of placement into Schedule V on June 22, 2009.[6]

Mechanism of Action and Pharmacodynamics

Lacosamide is a functionalized amino acid that produces activity in the maximal electroshock seizure test, like other antiepileptic drugs that are believed to act through voltage-gated sodium channels. Lacosamide enhances the slow inactivation of voltage-gated sodium channels without interacting with the fast inactivation of voltage-gated sodium channels. This inactivation prevents the channel from opening, and helps end the action potential. Many antiepileptic drugs, like carbamazepine or lamotrigine, slow the recovery from inactivation and hence reduce the ability of neurons to fire action potentials. Inactivation only occurs in neurons firing action potentials; this means that drugs that modulate fast inactivation selectively reduce the firing in active cells. Slow inactivation is similar but does not produce complete blockade of voltage gated sodium channels, with both activation and inactivation occurring over hundreds of milliseconds or more. Lacosamide makes this inactivation happen at less depolarized membrane potentials. This means that lacosamide only affects neurons which are depolarized or active for long periods of time, typical of neurons at the focus of epilepsy.[7] Lacosamide administration results in the inhibition of repetitive neuronal firing, the stabilization of hyperexcitable neuronal membranes, and the reduction of long-term channel availability, but does not affect physiological function.[8] Lacosamide has a dual mechanism of action. It also modulates collapsin response mediator protein 2 (CRMP-2), preventing the formation of abnormal neuronal connections in the brain.[9]

Lacosamide does not affect AMPA, kainate, NMDA, GABAA, GABAB or a variety of dopaminergic, serotonergic, adrenergic, muscarinic or cannabinoid receptors and does not block potassium or calcium currents.[10] Lacosamide does not modulate the reuptake of neurotransmitters including norepinephrine, dopamine, and serotonin.[11] In addition, it does not inhibit GABA transaminase.[12]

Pharmacokinetics

When administered orally in healthy individuals, lacosamide is rapidly absorbed from the gastrointestinal tract. Little of the drug is lost via the first pass effect, and thus has an oral bioavailability of nearly 100%.[13] In adults, lacosamide demonstrates a low plasma protein binding of <15, which reduces the potential for interaction with other drugs. Lacosamide is at its highest concentration in blood plasma approximately 1 to 4 hours after oral administration. Lacosamide has a half life of about 12-16 hours, which remains unchanged if the patients is also taking enzyme inducers. Consequently, the drug is administered twice per day at 12 hour intervals. Lacosamide is excreted renally, with 95% of the drug eliminated in the urine.[14] 40% of the compound remained unchanged from its original structure, while the rest of the elimination product consists of metabolites of lacosamide. Just 0.5% of the drug is eliminated in the feces.[15] The major metabolic pathway of lacosamide is CYP2C9, CY2C19, and CYP3A4-mediated demethylation. [16]

The dose-response curve for lacosamide is linear and proportional for oral doses of up to 800 mg and intravenous doses of up to 300 mg.[17] Lacosamide has low potential for drug-drug interactions, and no pharmacokinetic interactions have been found to occur with other antiepileptic drugs (AEDs) that act on sodium channels.[18] A study on the binding of lacosamide to CRMP-2 in Xenopus oocytes showed both competitive and specific binding. Lacosamide has a Kd value just under 5μM and a Bmax of about 200 pM/mg.[19] The volume of distribution (Vd) of lacosamide in plasma is 0.6 L/kg, which is close to the total volume of water. Lacosamide is ampiphilic and is this hydrophilic but also lipophilic enough to cross the blood-brain barrier.[20]

Dosage

Lacosamide is initially prescribed in oral doses of 50 mg twice daily, with a total dose of 100 mg/day.The dosing can be increased by 100 mg/day following a twice-daily dose up to a total dose of 200-400 mg/day. Clinical trials showed that a dose of 600 mg/day was not note effective than a dose of 400 mg/day, but resulted in more adverse reactions. Lacosamide is administered orally through film-coated tablets of 50 mg (pink), 100 mg (dark yellow), 150 mg (salmon), and 200 mg (blue). It can also be administered by injection at a concentration of 200 mg/20 mL or by oral solution at a concentration of 10 mg/mL.[21]

Preclinical trials

In preclinical trials, the effect of lacosamide administration on animal models of epilepsy was tested using the Frings audiogenic seizures (AGS)-susceptible mouse model of seizure activity with an effective dose (ED50) of 0.63 mg/kg, i.p.[22] The effect of lacosamide was also assessed using the maximal electroshock (MES) test to detect inhibition of seizure spread.[23] [24] Lacosamide administration was successful in preventing the spread of seizures induced by MES in mice (ED50 = 4.5 mg/kg, i.p.) and rate (ED50 = 3.9 mg/kg, p.o.).[25] In preclinical trials, administration of lacosamide in combination with other AEDs resulted in synergistic anticonvulsant effects. Lacosamide produced effects in animal models for essential tremor, tardive dyskinesia schizophrenia, and anxiety.[26] Preclinical trials found the S-stereoisomer to be less potent than the R-stereoisomer in the treatment of seizures.[27]

Clinical trials

Lacosamide was tested in three placebo-controlled, double-blind, randomized trials of at least 1300 patients.[28] In a multi center, multinational, placebo-controlled, double-blind, randomized clinical trial to determine the efficacy and safety of different doses of lacosamide on individuals with poorly controlled partial-onset seizures, lacosamide was found to significantly reduce seizure frequency when given in addition to other antiepileptics, at doses of 400 and 600 milligrams a day.[29] In a smaller trial of people with diabetic neuropathy, lacosamide also provided significantly better pain relief when compared to placebo.[30] Lacosamide administration in combination with 1-3 other AEDs was well-tolerated in patients. Lacosamide administered at 400 mg/day was found to significantly reduce pain in patients with diabetic neuropathy in a multi center, double-blind, placebo-controlled Phase III trial with a treatment duration of 18 weeks.[31]

Treatment

Lacosamide is an anticonvulsant compound approved for the adjunctive treatment of partial-onset seizures and neuropathic pain. Clinical trials are currently underway for the use of lacosamide as mono therapy for partial onset seizures.[32] There is no evidence that lacosamide provides additional value over current AEDs for the treatment of partial-onset seizures, but it may offer a safety advantage.[33] Newer AEDs, including lacosamide, vigabatrin, felbamate, gabapentin, tiagabine, and rifinamide have been found to be more tolerable and safer than older drugs such as carbamazepine, phenytoin, and valproate.[34]

Side-effects and tolerability

Lacosamide was generally well tolerated in adult patients with partial-onset seizures.[35] The side-effects most commonly leading to discontinuation were dizziness, ataxia, vomiting, diplopia (double vision), nausea, vertigo, and blurred vision. These adverse reactions were observed in at least 10% of patients.[36] Less common side-effects include forgetfulness, discouragement, feelings of sadness, and lack of appetite.

Gastrointestinal

Nausea, vomiting, diarrhea.

Central Nervous system

Dizziness was the most common treatment-related adverse event. Other CNS effects are headache, drowsiness, blurred vision, involuntary movements, weakness, tiredness, memory problems, diplopia, trembling or shaking of the hands, unsteadiness, ataxia.

Psychology

Panic attacks; agitation or restlessness; irritability and aggression, anxiety, or depression; suicidality; insomnia and mania; altered mood; false and unusual sense of well-being.

Cardiovascular

Postural hypotension, arrhythmias.

Allergies

Itching, rash[37], pruritus

Warnings

Suicidal behavior and ideation have been observed as early as one week after starting treatment with lacosamide, and is an adverse reaction from use of most AEDs. In clinical trials with a medial treatment duration of 12 weeks, the incidence of suicidal ideation was 0.43% among 27,863 patients as opposed to 0.24% among 16,029 placebo-treated patients. Suicidal behavior was observed in 1 of every 530 patients treated.[38]>

In Pregnancy

In a study conducted to asses the teratogenic potential of AEDs in the zebrafish embryo, the teratogenicity index of lacosamide was found to be higher than that of lamotigrine, levetiracetam, and ethosuximide. Lacosamide administration resulted in different malformations in the neonatal zebrafish depending on dosage.[39]

The FDA has assigned lacosamide to pregnancy category C. Animal studies have reported incidences of fetal mortality and growth deficit. Lacosamide has not been tested during human pregnancy, and should be administered with caution. In addition, it has not been determined whether the excretion of lacosamide occurs in breast milk.[40]

Off-label use

Lacosamide may have a variety of off-linel uses, including for pain management and treatment of mental health disorders. Lacosamide and other AEDs have been used off-label in the management of bipolar disorder, cocaine addiction, dementia, depression, diabetic peripheral neuropathy, fibromyalgia, headache, hiccoughs, Huntington's disease, mania, migraine, obsessive-compulsive disorder, panic disorder, restless leg syndrome, and tinnitus. Combinations of AEDs are often employed for seizure reduction. Studies are underway for the use of lacosamide as a mono therapy for partial onset seizures, diabetic neuropathy, and fibromyalgia.[41]

AEDs are often used in the treatment of hepatic and renal disease. Lacosamide falls into a category of drugs that are at risk of being extracted by hemodialysis.[42]

Chemistry

Lacosamide is a powdery, white to light yellow crystalline compound. The chemical name of lacosamide is (R)-2-acetamido-N-benzyl-3-methoxypropionamide and the systemic name is N2-Acetyl-N-benzyl-O-methyl-D-serinamide.[43] [44] Lacosamide is a functional amino acid molecule that has high solubility in water and DMSO, with a solubility of 20.1 mg/mL in phosphate-buffered saline (PBS, pH 7.5, 25°C).[45] [46] The molecule has six rotatable bonds and one aromatic ring. Lacosamide melts at 143-144°C and boils at 536.447°C at a pressure of 760 mmHg.[47] [48]

Synthesis

The following three-step synthesis of lacosamide was proposed in 1996.

500pm

(R)-2-amino-3-hydroxypropanoic acid is treated with acetic anhydride and acetic acid. The product is treated first with N-methylmorpholine, isobutyl chloroformate, and benzylamine, next with methyl iodide and silver oxide, forming lacosamide.[49]

More efficient routes to synthesis have been proposed in recent years, including the following.[50] [51]


References

  1. ^ a b "UCB Announces FDA Filing for lacosamide in the Treatment of Diabetic Neuropathic Pain" (Press release). UCB. 2007-11-29. Retrieved 2007-11-29.
  2. ^ "UCB Announces FDA Filing for lacosamide in the Treatment of Partial Onset Seizures in Adults with Epilepsy" (Press release). UCB. 2007-11-29. Retrieved 2007-11-29.
  3. ^ Wan, Yuet (August 17, 2007). "Marketing application for lacosamide (Vimpat) filed in EU for treatment of diabetic neuropathic pain". PharmaTimes through the UK National electronic Library for Medicines. Retrieved 2007-11-30. {{cite news}}: Italic or bold markup not allowed in: |publisher= (help) [dead link]
  4. ^ "Vimpat Approved in Europe" (Press release). UCB. 2008-09-03. Retrieved 2008-09-17.
  5. ^ "UCB's Vimpat approved by U.S. FDA as adjunctive therapy for partial onset seizures in adults" (Press release). UCB. 2008-10-29. Retrieved 2008-11-25.
  6. ^ "FDA places lacosamide in Schedule V" (Press release). FDA. 2009-06-22. Retrieved 2009-06-28.
  7. ^ Errington AC, Stöhr T, Heers C, Lees G (January 2008). "The investigational anticonvulsant lacosamide selectively enhances slow inactivation of voltage-gated sodium channels". Molecular Pharmacology. 73 (1): 157–69. doi:10.1124/mol.107.039867. PMID 17940193.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ Doty, P (2013). "Development of lacosamide for the treatment of partial-onset seizures". Ann N Y Acad Sci. 1291: 56–68. doi:10.1111/nyas.12213. PMID 23859801. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. ^ "SCHWARZ PHARMA Highlights the Results of 13 Lacosamide Data Presentations at North American Regional Epilepsy Congress in San Diego". Schwarz Pharma. 5 December 1996. Retrieved 2 April 2014.
  10. ^ Errington AC, Coyne L, Stöhr T, Selve N, Lees G (June 2006). "Seeking a mechanism of action for the novel anticonvulsant lacosamide". Neuropharmacology. 50 (8): 1016–29. doi:10.1016/j.neuropharm.2006.02.002. PMID 16620882.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ Beyreuther, BK (2007 Spring). "Lacosamide: a review of preclinical properties". CNS drug reviews. 13 (1): 21–42. PMID 17461888. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  12. ^ Errington, AC (2006 Jun). "Seeking a mechanism of action for the novel anticonvulsant lacosamide". Neuropharmacology. 50 (8): 1016–29. PMID 16620882. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. ^ Hovinga, CA (2003). "SPM-927 (Schwarz Pharma)". IDrugs. 6 (5): 479-85. PMID 12789603. Retrieved 2 April 2014.
  14. ^ Italiano, D (2013). "Clinical pharmacokinetics of new-generation antiepileptic drugs at the extremes of age: an update". Clin Pharmacokinet. 52 (8): 627–45. doi:10.1007/s40262-013-0067-4. PMID 23640503. Retrieved 2 April 2014. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  15. ^ "Lacosamide". DrugBank. Retrieved 2 April 2014.
  16. ^ Abou-Khalil, BW (2009). "Lacosamide: what can be expected from the next new antiepileptic drug?". Epilepsy Curr. 9 (5): 133–4. doi:10.1111/j.1535-7511.2009.01317.x. PMID 19826503. {{cite journal}}: |access-date= requires |url= (help)
  17. ^ Bialer, M (2004). "Progress report on new antiepileptic drugs: a summary of the Seventh Eilat Conference (EILAT VII)". Epilepsy Res. 61 (1–3): 1–48. PMID 15570674. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  18. ^ "Therapeutic Class Review" (PDF). RegenceRx. Retrieved 2 April 2014.
  19. ^ "Method for identifying CRMP modulators". Retrieved 2 April 2014.
  20. ^ Stoht, T (2007). "Lacosamide, a novel anti-convulsant drug, shows efficacy with a wide safety margin in rodent models for epilepsy". Epilepsy Res. 74 (2–3): 147–54. PMID 17433624. Retrieved 2 April 2014. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  21. ^ "Highlights of Prescribing Information" (PDF). Vimpat. Retrieved 2 April 2014.
  22. ^ Beyreuther, BK (2007). "Lacosamide: a review of preclinical properties". CNS Drug Rev. 13 (1): 21–42. PMID 17461888. Retrieved 2 April 2014. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  23. ^ Borowicz, KK (1997). "Influence of isradipine, niguldipine and dantrolene on the anticonvulsive action of conventional antiepileptics in mice". Eur J Pharmacol. 323 (1): 45–51. PMID 9105875. Retrieved 2 April 2014. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  24. ^ Swinyard, EA (1952). "Comparative assays of antiepileptic drugs in mice and rats". J Pharmacol Exp Ther. 106 (3): 319–20. PMID 13000628. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  25. ^ Beyreuther, BK (2007). "Lacosamide: a review of preclinical properties". CNS Drug Rev. 13 (1): 21–42. PMID 17461888. Retrieved 2 April 2014. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  26. ^ "SCHWARZ PHARMA Highlights the Results of 13 Lacosamide Data Presentations at North American Regional Epilepsy Congress in San Diego". Schwarz Pharma. 5 December 2006. Retrieved 2 April 2014.
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