SWITCHING FROM ORAL LACOSAMIDE TO ORAL LEVETIRACETAM
Clinical Statement: Compared to lacosamide, levetiracetam is equally effective, may be more tolerable, and is less costly. Use lacosamide with caution in patients with dysfunction in cardiac conduction. Levetiracetam has potential neuropsychiatric side effects.
Lacosamide and levetiracetam are antiepileptic drugs (AEDs).
Lacosamide is significantly more costly than levetiracetam (20-25 times more expensive.)
Lasosamide – each tablet range is from $7.34 to $12.16 (50mg ($7.34), 100mg ($11.48), 150mg ($12.16), 200mg ($12.16))
Levetiracetam – each tablet range is from $0.35 to $0.60 (250mg ($0.35), 500mg ($0.44), 750mg ($0.60)
- Study aim: Compare the efficacy and tolerability of newer AEDs (like lacosamide [LAC]) with levetiracetam (LEV), when used as add-on treatments for uncontrolled focal epilepsy
- 24 RCTs and 8540 total patients were included
- Results: Compared to LEV, lacosamide (LAC) did not show significant difference in efficacy at all dose levels and may also have worse tolerability
- Study aim: Compare the efficacy and tolerability of LAC or LEV as monotherapy in elderly patients with focal onset epilepsy
- 46 patients > 65 years of age included
- Results: Efficacy and tolerability were comparable with LAC and LEV
- Study aim: Review data from 5 audits with AEDs in focal epilepsy
- Patients with uncontrolled partial-onset seizures (LEV n=136; LAC n=160)
- Results: Freedom from seizures was similar for patients taking LEV compared to those taking LAC
- Study aim: Review pharmacological treatment of epileptic emergencies
- Expert opinion: In management of status epilepticus and seizure clusters, levetiracetam is considered a good option in frail and elderly patients. Lacosamide is mainly used as second-line treatment after failure of valproate, fosphenytoin, and levetiracetam.
- Metabolism is independent of CYP system, thus limiting potential for interactions with other drugs
- No requirement of routine monitoring of drug levetiracetam levels
- Levetiracetam has potential neuropsychiatric side effects (ie somnolence, fatigue, dizziness, asthenia, ataxia, possible increased agitation and aggression in those with underlying behavioral problems)
- Strong CYP inhibitors (eg valproate) may reduce elimination if hepatic or renal impairment is present
- Most frequent reported side effects include: dizziness, nausea, vertigo, ataxia, abnormal coordination
- Potential for PR interval prolongation, thus caution should be taken in patients with known cardiac conduction problems, severe ischemic/structural heart disease, or concomitant use of medications that prolong the PR interval