Lacosamide Strides

What Is Lacosamide Strides and What Is It Used For?

Lacosamide Strides is a prescription antiepileptic medicine containing lacosamide as an oral solution (10 mg/ml). It is used to treat focal (partial-onset) seizures in adults, adolescents, and children from 2 years of age, either as monotherapy or in combination with other antiepileptic drugs.

Lacosamide belongs to a class of medications known as functionalized amino acids, which represents a relatively novel category of antiepileptic drugs. Unlike many traditional antiepileptics, lacosamide has a unique mechanism of action: it selectively enhances the slow inactivation of voltage-gated sodium channels. This means that while normal neuronal activity remains largely unaffected, the hyperexcitable neurons responsible for seizure initiation and propagation are preferentially stabilized.

The oral solution formulation of Lacosamide Strides provides 10 mg of lacosamide per milliliter, making it particularly suitable for patients who have difficulty swallowing tablets, including young children and elderly individuals with dysphagia. The liquid form also allows for more precise dose adjustments during the titration phase, which is an important clinical advantage when finding the optimal therapeutic dose for each patient.

Focal seizures, previously known as partial-onset seizures, originate in a specific area of one hemisphere of the brain. They can manifest in various ways depending on the brain region involved — from brief episodes of altered awareness or involuntary movements to more complex episodes involving confusion and impaired consciousness. Some focal seizures can spread to involve both hemispheres, a phenomenon known as secondary generalization, which results in a tonic-clonic (grand mal) seizure. Lacosamide is effective against all these manifestations of focal seizures.

Clinical trials have demonstrated that lacosamide is effective both as a sole treatment (monotherapy) for newly diagnosed epilepsy and as an additional treatment (adjunctive therapy) for patients whose seizures are not adequately controlled by other antiepileptic drugs. The European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA) have both approved lacosamide for these indications based on robust clinical evidence from multiple randomized controlled trials.

What Should You Know Before Taking Lacosamide Strides?

Before starting Lacosamide Strides, inform your doctor about all medical conditions, particularly heart problems, liver or kidney disease, and any history of depression or suicidal thoughts. Lacosamide can cause cardiac conduction disturbances and may interact with other medications.

Contraindications

Lacosamide Strides must not be used if you are allergic to lacosamide or any of the other ingredients in the medicine. Additionally, lacosamide is contraindicated in patients with known second- or third-degree atrioventricular (AV) block, as the drug can further impair cardiac conduction. Patients with these conditions face a significant risk of serious cardiac complications, including complete heart block, if lacosamide is administered.

Before prescribing lacosamide, healthcare providers should obtain a thorough cardiac history and may request an electrocardiogram (ECG) to assess baseline cardiac conduction. This is particularly important for elderly patients and those with known cardiovascular disease, as these populations are more susceptible to PR interval prolongation, a hallmark effect of lacosamide on the heart.

Warnings and Precautions

Several important warnings apply to the use of Lacosamide Strides. Cardiac conduction disturbances are among the most clinically significant concerns. Lacosamide causes dose-dependent prolongation of the PR interval on electrocardiography. While this is usually clinically insignificant in otherwise healthy patients, it can become problematic in individuals with pre-existing conduction disorders, those taking other PR-prolonging drugs, or patients with severe cardiac disease.

Like all antiepileptic drugs, lacosamide carries a warning regarding suicidal thoughts and behavior. Analysis of clinical trial data across multiple antiepileptic medications has shown a small but statistically significant increase in suicidal ideation and behavior. Patients and caregivers should be advised to monitor for signs of depression, unusual changes in mood or behavior, and suicidal thoughts, and to report any such symptoms to their healthcare provider immediately.

Dizziness and ataxia are dose-dependent adverse effects that can increase the risk of falls, particularly in elderly patients. Patients should be cautioned about driving and operating heavy machinery until they understand how lacosamide affects them. The drug can also cause visual disturbances, including diplopia (double vision) and blurred vision, which may further impair the ability to drive safely.

Patients with hepatic impairment require careful dosing adjustments. In patients with mild to moderate hepatic impairment, a lower maximum dose is recommended. Lacosamide is not recommended for patients with severe hepatic impairment due to insufficient clinical data in this population. Similarly, patients with severe renal impairment (creatinine clearance ≤30 ml/min) and those on haemodialysis require dose adjustments and close monitoring.

Pregnancy and Breastfeeding

The use of lacosamide during pregnancy requires careful risk-benefit assessment. Animal reproductive studies have revealed evidence of developmental toxicity, including increased perinatal mortality and growth retardation. However, these studies were conducted at doses above the recommended human dose, and their direct applicability to human pregnancy is uncertain.

There is limited data from the use of lacosamide in pregnant women. Pregnancy registries are actively collecting data to better characterize the risk. As with all antiepileptic drugs, the decision to use lacosamide during pregnancy must weigh the risk of uncontrolled seizures to both mother and fetus against the potential drug-related risks. Uncontrolled seizures during pregnancy can result in serious harm, including injury, aspiration pneumonia, and, rarely, death of the mother or fetus.

Women of childbearing potential should discuss effective contraception with their healthcare provider before starting lacosamide. If pregnancy occurs or is planned, medical advice should be sought immediately. The dose of lacosamide may need adjustment during pregnancy due to physiological changes in drug metabolism. Lacosamide is excreted in human breast milk, and the decision to breastfeed during lacosamide treatment should consider the benefit of breastfeeding against the potential risk to the infant.

How Does Lacosamide Strides Interact with Other Drugs?

Lacosamide has a favorable drug interaction profile compared to many older antiepileptics. However, it can interact with PR-prolonging drugs and strong enzyme-inducing antiepileptics such as carbamazepine, phenytoin, and phenobarbital, which may reduce lacosamide levels.

One of the clinical advantages of lacosamide is its relatively low potential for drug-drug interactions. Lacosamide is minimally bound to plasma proteins (<15%) and is not a significant inhibitor or inducer of cytochrome P450 enzymes. This means it is less likely than many older antiepileptic drugs to alter the blood levels of concomitant medications or to be affected by them.

However, several clinically important interactions do exist. Strong enzyme-inducing antiepileptic drugs — specifically carbamazepine, phenytoin, and phenobarbital — can reduce plasma concentrations of lacosamide by approximately 25% by inducing the CYP3A4 and CYP2C9 enzymes responsible for lacosamide metabolism. When these drugs are co-administered, higher doses of lacosamide may be necessary to achieve therapeutic efficacy, and close monitoring of seizure control is advisable.

The most important pharmacodynamic interaction involves drugs that prolong the PR interval on electrocardiography. Co-administration of lacosamide with other PR-prolonging agents, such as certain antiarrhythmic drugs (e.g., amiodarone, flecainide), beta-blockers, calcium channel blockers (e.g., verapamil, diltiazem), and other sodium channel-blocking antiepileptic drugs (e.g., carbamazepine, lamotrigine), can result in additive PR prolongation and increased risk of AV block. ECG monitoring is recommended before and during combination therapy.

It is worth noting that lacosamide does not significantly affect the plasma concentrations of commonly co-prescribed antiepileptic drugs such as levetiracetam, valproate, topiramate, or zonisamide. It also does not interact with oral contraceptives, which is an important clinical advantage for women of childbearing potential who require reliable contraception.

What Is the Correct Dosage of Lacosamide Strides?

The typical adult maintenance dose of lacosamide is 200–400 mg/day, divided into two equal doses. Treatment is started at a low dose and gradually increased. The oral solution delivers 10 mg per milliliter, allowing precise dose titration. Dosage must be adjusted for liver and kidney impairment.

Dosing of Lacosamide Strides must be individualized based on the patient's age, weight, renal and hepatic function, concomitant medications, and clinical response. The oral solution (10 mg/ml) is administered twice daily — morning and evening — with or without food. The solution should be measured using the graduated measuring cup or oral syringe provided with the product to ensure accurate dosing.

Adults and Adolescents (≥50 kg)

Children (2 to 17 years, <50 kg)

Elderly Patients

No dose reduction is specifically required based on age alone. However, age-related reductions in renal function should be considered when determining the appropriate dose. Elderly patients are also more susceptible to the dose-dependent adverse effects of lacosamide, particularly dizziness and cardiac conduction effects. Therefore, a more cautious titration approach is advisable, with careful monitoring of ECG parameters and close attention to symptoms such as dizziness, syncope, and falls.

Missed Dose

If you miss a dose, take it as soon as you remember. However, if it is nearly time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a forgotten dose. Consistency in timing is important for maintaining stable blood levels of the drug and optimal seizure control.

Overdose

In case of suspected overdose, seek immediate medical attention. Symptoms of lacosamide overdose may include severe dizziness, nausea, vomiting, cardiac conduction disturbances (including prolonged PR interval and AV block), seizures, and reduced level of consciousness including coma. There is no specific antidote for lacosamide overdose. Treatment is supportive, and haemodialysis can effectively remove lacosamide from the blood (approximately 50% of the drug is removed during a 4-hour haemodialysis session).

What Are the Side Effects of Lacosamide Strides?

The most common side effects of lacosamide include dizziness, headache, nausea, and diplopia (double vision). Most side effects are dose-dependent and tend to be most pronounced during the initial titration period. Serious side effects, though rare, include cardiac conduction disturbances and severe skin reactions.

Like all medicines, Lacosamide Strides can cause side effects, although not everybody gets them. The majority of adverse effects associated with lacosamide are dose-dependent, meaning they are more likely to occur at higher doses and during the initial period of dose titration. Most side effects are mild to moderate in severity and tend to diminish as the body adjusts to the medication over the first few weeks of treatment.

Understanding the frequency of side effects helps patients and caregivers know what to expect and when to seek medical advice. Side effects are classified according to standard medical conventions based on their frequency of occurrence in clinical trials. The following grid summarizes the known side effects organized by frequency category.

If you experience any cardiac symptoms such as slow or irregular heartbeat, feeling faint, or loss of consciousness, seek medical attention immediately. Similarly, any signs of a severe skin reaction — widespread rash, blistering, peeling skin, fever, or swollen lymph nodes — require urgent medical evaluation. Symptoms suggesting a serious allergic reaction, including difficulty breathing, swelling of the face or throat, or widespread hives, also warrant emergency medical care.

How Should You Store Lacosamide Strides?

Store Lacosamide Strides oral solution below 30°C. Do not freeze. Keep the bottle tightly closed and protect from light. After first opening, use within the timeframe specified on the packaging. Keep out of sight and reach of children.

Proper storage of medicines is essential to maintain their efficacy and safety throughout the treatment period. Lacosamide Strides oral solution should be stored at room temperature, not exceeding 30°C (86°F). The medicine should not be refrigerated or frozen, as temperature extremes can alter the stability and consistency of the oral solution formulation.

Keep the bottle in the original packaging to protect from light when not in use. After opening the bottle for the first time, note the date on the label. The oral solution has a defined shelf life after first opening, which is specified on the product packaging — typically this is a period of several weeks. Any remaining solution after this period should be discarded, even if it appears unchanged, as the chemical stability of the active ingredient cannot be guaranteed beyond the recommended period.

Always keep this medicine out of the sight and reach of children. Do not use the medicine after the expiry date printed on the packaging. Do not dispose of medicines via household waste or wastewater. Ask your pharmacist about proper disposal methods for medicines you no longer need. These measures help to protect the environment and prevent accidental exposure.

What Does Lacosamide Strides Contain?

Each milliliter of Lacosamide Strides oral solution contains 10 mg of the active substance lacosamide. The solution also contains excipients that serve as solvents, sweeteners, flavorings, and preservatives to ensure stability and palatability.

The active substance in Lacosamide Strides is lacosamide (chemical name: (R)-2-acetamido-N-benzyl-3-methoxypropionamide). Each milliliter of oral solution contains precisely 10 mg of lacosamide. Lacosamide is a white to light yellow crystalline powder that is freely soluble in water, making it well-suited for an oral solution formulation.

The inactive ingredients (excipients) in the oral solution include purified water as the base solvent, along with sweetening agents to improve palatability — this is particularly important for pediatric patients who may find unsweetened medicinal solutions difficult to take. A flavoring agent (typically strawberry flavor) is added to further enhance acceptance, especially in younger patients. Preservatives are included to maintain microbiological stability throughout the shelf life of the product.

Patients with known allergies or intolerances to any excipients should review the full list of ingredients provided on the product packaging or in the patient information leaflet before starting treatment. Some oral solution formulations may contain sodium or sorbitol, which can be relevant for patients on sodium-restricted diets or those with hereditary fructose intolerance. If you are unsure about any ingredient, consult your pharmacist or prescribing physician for clarification.

Frequently Asked Questions About Lacosamide Strides