Last update: Oct. 31, 2018

Lacosamide

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

An antiepileptic indicated in partial-onset epileptic seizures (EMA2107, FDA 2014).
Off-label it is used to treat neuropathic pain, fibromyalgia, osteoarthritis and migraine prophylaxis (Alcántara 2016, Moulin 2014, Gómez 2014), although with disputed evidence of its effectiveness (Wiffen 2013, McCleane 2013). Oral administration twice a day.

Its pharmacokinetic data (low molecular weight, low protein binding, high pKa) explains the potentially significant amounts transferred to breastmilk, with a very high relative dose, around 19% (Zárubová 2016).

However, other authors have found minimal excretion in the breastmilk of a mother who took lacosamide and levetiracetam throughout pregnancy and at the beginning of breastfeeding, with a relative dose of 1.8%. The mother stopped breastfeeding at 15 days due to drowsiness and insufficient feeding in the infant, who was born premature at 36 weeks, although the plasma levels in the infant were very low. At 7 months the infant showed good psychomotor development (Ylikotila 2015).

No problems of somatic or psychomotor development were observed at 18, 24 and 36 months of age in three infants whose mothers took lacosamide at doses of 300 and 400 mg/day in mono or polytherapy for 7, 8 and 9 months. Levels were not measured in milk or in the infants (Lattanzi 2017).

Until there is more published data on this drug in relation to breastfeeding, safer known alternatives may be preferable, especially during the neonatal period and in case of prematurity.

Given the strength of existing evidence on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of this medication, advising mothers who wish to continue breastfeeding on an individual basis (Crettenand 2018).


See below the information of this related product:

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Lacosamide is also known as


Lacosamide in other languages or writings:

Group

Lacosamide belongs to this group or family:

Tradenames

Main tradenames from several countries containing Lacosamide in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 250 daltons
Protein Binding < 15 %
VD 0,6 l/Kg
pKa 12,47 -
Tmax 0,5 - 4 hours
T1/2 13 hours
M/P ratio 0,1 -/- 1 -
Theoretical Dose 0,06 -/- 0,64 mg/Kg/d
Relative Dose 1,8 -/- 19,3 %

References

  1. Crettenand M, Rossetti AO, Buclin T, Winterfeld U. [Use of antiepileptic drugs during breastfeeding : What do we tell the mother?] Nervenarzt. 2018 Abstract
  2. EMA-UCB. Lacosamida (Vimpat). Ficha técnica. 2017 Full text (in our servers)
  3. EMA-UCB. Lacosamide (Vimpat). Drug Summary. 2017 Full text (in our servers)
  4. Lattanzi S, Cagnetti C, Foschi N, Provinciali L, Silvestrini M. Lacosamide during pregnancy and breastfeeding. Neurol Neurochir Pol. 2017 May - Jun;51(3):266-269. Abstract
  5. Zárubová J, Kremláckova V, Borecká K, Marusic P. Plasma and breast milk levels of lacosamide before, during and post pregnancy. 12th European Congress on Epileptology. Poster 193. Epilepsia. 2016 Full text (link to original source) Full text (in our servers)
  6. Alcántara-Montero A, Sánchez-Carnerero CI. [Lacosamide and neuropathic pain, a review]. Rev Neurol. 2016 Abstract
  7. Ylikotila P, Ketola RA, Timonen S, Malm H, Ruuskanen JO. Early pregnancy cerebral venous thrombosis and status epilepticus treated with levetiracetam and lacosamide throughout pregnancy. Reprod Toxicol. 2015 Abstract
  8. FDA. Lacosamide. Drug Summary. 2014 Full text (in our servers)
  9. Gómez-Argüelles JM, Bermejo PE, Lara M, Almajano J, Aragón E, García del Carrizo F, Blanco MV, Valenzuela-Rojas FJ, Colás J, Sánchez-Del Valle O, Ceballos MÁ, Toribio-Díaz ME, Latorre-González G, Costa-Frossard L, Morin-Martin Mdel M. [Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial]. Rev Neurol. 2014 Abstract
  10. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, Furlan A, Gilron I, Gordon A, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamson OD; Canadian Pain Society.. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014 Abstract
  11. Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, Lunn MP, Hamunen K, Haanpaa M, Kalso EA. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013 Abstract
  12. McCleane G. Lacosamide for pain. Expert Opin Investig Drugs. 2010 Abstract

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