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Tolerability of lacosamide rapid dose titration: A randomized, multicenter, prospective, open-label study

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Author(s)
Yong-Won ShinJangsup MoonYong Won ChoDong Wook KimSang Bin HongDo-Yong KimHyeyeon ChangSeo Hyun YoonKyung-Sang YuIn-Jin JangSoon-Tae LeeKeun-Hwa JungKyung-Il ParkKi-Young JungManho KimKon ChuSeungHwan LeeSang Kun Lee
Keimyung Author(s)
Cho, Yong Won
Department
Dept. of Neurology (신경과학)
Journal Title
Epilepsy and Behavior
Issued Date
2021
Volume
115
Keyword
LacosamideTitrationAdverse eventSafety
Abstract
Objective:
Currently recommended dosing of lacosamide often necessitates long titration periods. However, the use of a regimen consisting of initial loading dose of 200 mg followed by a maintenance dose of 200 mg/day in practice suggests tolerability of more rapid titration schedules. We aimed to clarify whether the shortened titration schedule affects tolerability of lacosamide.

Methods:
We evaluated the safety of two rapid titration protocols designed to reach the target dose of 400 mg/day within 1 week, and the conventional weekly titration protocol (reaching the target dose of 400 mg/day in three weeks). The ≥50% responder rate and steady-state plasma concentration of lacosamide were also analyzed. Adverse events were assessed at 1 week and 5 weeks after reaching the target dose.

Results:
Seventy-five patients with epilepsy were enrolled and evenly distributed to three titration protocols, from which 5 patients were lost to follow-up and excluded from the safety analysis. Discontinuation of lacosamide or dose reductions due to adverse events occurred in 32 patients (46%), of whom a large majority (74%) had experienced adverse events after reaching 400 mg/day, demonstrating apparent dose-dependency. There was no difference in safety outcomes among the three titration groups. Concomitant use of sodium channel blockers significantly increased the risk of adverse events.

Conclusion:
Rapid titration protocols for lacosamide were not associated with an increased risk of adverse events compared to the conventional weekly titration protocol. Uptitration of lacosamide at shorter intervals to an effective target dosage may be feasible in appropriate clinical situations.
Keimyung Author(s)(Kor)
조용원
Publisher
School of Medicine (의과대학)
Citation
Yong-Won Shin et al. (2021). Tolerability of lacosamide rapid dose titration: A randomized, multicenter, prospective, open-label study. Epilepsy and Behavior, 115, 107663. doi: 10.1016/j.yebeh.2020.107663
Type
Article
ISSN
1525-5069
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S152550502030843X
DOI
10.1016/j.yebeh.2020.107663
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43440
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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