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Vimpat (VIM-pat) is the brand name used in the United States and some other countries for the seizure medicine lacosamide (la-COS-a-mide).

Vimpat (VIM-pat) is the brand name used in the United States and some other countries for the seizure medicine lacosamide (la-COS-a-mide).

VIMPAT (lacosamide) tablets are indicated for use alone or as add-on therapy in the treatment of partial-onset (focal) seizures in patients with epilepsy who are 17 years of age or older. 

Use can be in partial-onset seizures with or without secondary generalization to tonic-clonic (previously called grand mal) seizures. This means that seizures may start in one part of the brain (as in a simple or complex partial seizure) or spread to a generalized seizure that may be tonic clonic or grand mal seizure.

VIMPAT (lacosamide) injection for intravenous use is indicated when a person at least 17 years old with partial seizures temporarily cannot take the medicine by mouth. For example, it may be used if a person is very sick or having a surgical procedure. This form of medicine is given through a special atheter or intravenous line that is placed in a person's vein. Special equipment and medical help is needed to give the drug in this way and it is usually done only in hospital settings.

Vimpat
Tablet
Vimpat 50mg

50-mg (pink)

Vimpat 100mg

100-mg (dark yellow)

Vimpat 150mg

150-mg (salmon)

Vimpat 200mg

200-mg (blue) film-coated tablets

Liquid Injection

200-mg in each-20 mL single-use vial for intravenous use

Used to Treat

  • Complex Partial Seizures
  • Simple Partial Seizures

Forms

Vimpat is marketed in the United States by UCB Pharma, Inc. The name or look of the medicine may be different in other countries. The dose (measured in milligrams, abbreviated "mg") will usually be the same. These descriptions apply to the U.S. versions of lacosamide:

How to Take and Store

For adults, Vimpat is usually started at 50 milligrams (mg) twice daily. The dosage can be increased to 100 mg twice a day after a week, then 150 mg twice a day for a week, then 200 mg twice a day. Dosage usually would be continued at 200 mg twice a day (400 mg per day total). For people who are particularly prone to medication side effects, the initiation may start more slowly.

In August 2014, the FDA approved a single loading dose option for all formulations of of Vimpat.

  • A single dose of 200 mg can be given as the first dose.
  • Twelve hours later, the dosing can be changed to 100 mg twice a day.
  • Further increases are usually made weekly, increasing by 100 mg at a time as needed until the maintenance dose is reached. 

You should plan the medication schedule with your doctor.

How to take and store Lacosamide?

Follow your doctor's directions. Call if you have any questions. Usually, the drug is started by taking 50 mg twice a day, for a total of 100 mg daily (100 mg/day). The dose may be increased each week by 100 mg each day and given in two doses each day. Usually the total daily dose is between 200 to 400 mg each day. The amount a person needs depends on how well it works and how well they tolerate it. The drug may be swallowed whole or crushed and mixed with food. Swallowing the drug whole with a glass of water helps avoid a bitter taste. Vimpat is well-absorbed from the stomach and can be taken with or without food. It's a good idea to be consistent about how you take it and take it the same way each day.

Be careful if the doctor writes a new prescription using a different kind of pill. For example, if you've been using 50-mg tablets and the new prescription is for 100-mg tablets, be careful to use the correct number. Don't automatically continue to use the same number of pills as before.

Be sure to use only the amount that the doctor prescribes. If you think you've used one or two extra tablets, call your doctor for advice. If an overdose of the medicine has been taken, call your local poison control center or emergency room right away, unless you have special instructions from the doctor.

Don't stop taking Vimpat or change the amount you use without talking to the doctor first. Stopping any seizure medicine all at once can cause a serious problem called status epilepticus.

All forms of Vimpat should be stored at room temperature, away from light and moisture. Keep all medicines out of the reach of children. The manufacturer recommends storing Vimpat at 20° to 25°C (68° to 77°F). You may take it with you on excursions of temperatures between 15° to 30°C (59° to 86°F). The drug may be stable at greater extremes of temperature, but information is lacking.

What if I forget?

If you forget a dose of Vimpat, take it as soon as you remember. If it is almost time for the next dose, delay that dose for a few hours instead of taking two doses very close together. Then go back to the regular schedule. Do your best to follow the doctor's directions. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you. Write down any missed doses on a seizure calendar too. Share this with the doctor so they can help you with this.

Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!

How does Lacosamide effect the brain?

Brain cells need to work (fire) at a certain rate to function normally. During a seizure, brain cells are forced to work much more rapidly than normal. How Vimpat helps prevent brain cells from working as fast as a seizure requires is still being investigated, but in general Vimpat appears to slow firing of brain cells. This is useful in “cooling down” buildups of electrical discharges in the brain that could lead to seizures.

How does the body digest Lacosamide?

The process of absorbing, digesting, and getting rid of a medicine or food is called metabolism. The way the body metabolizes a particular medicine affects how often it must be taken. It also determines if it will interact with other medicines or be affected by conditions such as liver disease.

After taking Vimpat tablets, peak blood levels are reached in 1-4 hours. The amount of time it takes for the blood level to fall by half is generally around 13 hours. Vimpat is usually taken two times a day. Vimpat is partially metabolized in the liver and it is then cleared from the body in the urine by the kidneys. People with poor kidney function usually need to take less Vimpat and may take it less often, because it stays in their body longer.

How well does the Lacosamide work?

Vimpat (lacosamide) is generally used as add-on (adjunctive) therapy for partial seizures in individuals age 17 years and older whose seizures are not well controlled by other medications.

Before being approved for marketing in most countries, regulatory authorities (the FDA in the US) review results of clinical trials that must document that the medication is effective for the purpose stated and is reasonably safe. Clinical trials of seizure medicines, including Vimpat, usually are done by adding on the medicine to regimens that are not working well. Therefore, the benefit of a new drug seen in tests usually is incremental, and in people who have seizures that are proven to be difficult to control. A drug might be expected to show greater degrees of benefit in people whose seizures are not so severe, though data on this point usually are lacking.

Studies of Vimpat were performed on patients who had an average of 10-17 partial seizures per month, and usually were taking 2 or 3 other seizure medicines. At a dose of 200 mg per day, median seizure frequency reduction was in the range of 21-26%. At a dose of 400 mg per day, median seizure frequency reduction was in the range of 35-40%. About 40% of the patients taking 400 mg per day had seizure frequency cut in half or better. Little additional benefit occurred at 600 mg per day.

What are the most common side effects of Lacosamide?

When it was tested as an add-on treatment for epilepsy before its FDA approval, 17% of the people taking Vimpat 400 mg per day stopped taking it or lowered their dosage because of side effects, compared to 5% of people taking an inactive placebo.

The table below shows side effects of Vimpat 400 mg per day, versus side effects on placebo. The third numerical column is the difference.

Side Effect Placebo VIMPAT
400 mg/d
Drug-Placebo
    % %
Dizziness 8 30 22
Headache 9 14 5
Nausea 4 11 7
Double vision 2 10 8
Vision blurred 3 9 6
Vomiting 3 9 6
Sleepiness 5 8 3
Fatigue 6 7 1
Unsteadiness 2 7 5
Tremor 4 6 2
Diarrhea 3 5 2
Jerky eye movts 4 5 1
Balance disorder 0 5 5
Bruises 3 4 1
Vertigo 1 3 2
Skin cuts 2 3 1
Gait disturbance <1 2 2
Weakness 1 2 1
Memory loss 2 2 0
Depression 1 2 1
Itching 1 2 1

Individual patients reported various side effects, though it usually was not clear that these resulted from Vimpat versus one of their concurrently taken seizures medicines or other causes. These included: heart racing or irregularity, ringing in the ears, constipation, stomach upset, dry or tingling mouth, irritability, feverishness, a drunken feeling, muscle spasms, skin tingling, thinking problems, slurred speech, disturbance in attention, imbalance, confusion, mood alteration, depression. One patient in 4011 who took Vimpat developed a hypersensitivity reaction with liver and kidney failure. This person recovered. Depression and increased risk of suicide have been noted with the general class of antiepileptic drugs. Additional side effects will become evident as more experience is gained with the drug. Certain infrequent side effects do not appear until hundreds or thousands have taken the drug under a variety of conditions or for many years.

Laboratory abnormalities

Blood tests sometimes show abnormalities in patients taking Vimpat. Liver abnormalities were seen in blood tests of 7 of 935 patients (0.7%). A few patients had lowering of blood counts which could potentially lead to anemia or lowering of resistance to infection. Electrocardiograms (EKGs) of heart rhythms showed prolongation of conduction of the electrical signal in the heart (called PR prolongation) in 0.4% (4/944) of patients randomized to receive VIMPAT and 0% (0/364) of patients randomized to receive placebo.

Who should not take Lacosamide?

The only people for whom Vimpat is contraindicated are those who are allergic to it or any of its inactive ingredients. Because it is mostly excreted by the kidneys, doctors are cautious about prescribing Vimpat for people with kidney disorders. Patients with heart conduction problems should be especially cautious when taking Vimpat.

Can Lacosamide be taken with other medicines?

Any time a doctor suggests a new prescription, be sure to talk about what other medicines, supplements, herbs, and vitamins are already being taken. Sometimes one kind of medicine changes the way another kind of medicine works in the body. If two kinds of medicine affect each other, the doctor may prescribe something else or change the amount to be taken.

In clinical trials, Vimpat did not appear to have significant interactions with other antiepileptic drugs, contraceptives or several other tested medications. However, this does not rule out drug interactions in individual patients.

What are the effects of Lacosamide on Children?

Vimpat was tested in people 17 years of age and older. Most effective seizure medications are usually effective at all ages, but side effects and dosages can differ. Because Vimpat affects the brain growth factor, CRMP-2, a possible negative effect on brain development in young children cannot be ruled out.

If a woman takes Lacosamide during pregnancy will it hurt the baby?

The U.S. Food and Drug Administration (FDA) lists Vimpat in Pregnancy Category C, indicating that increased mortality could be seen in pregnant rats given Vimpat. Whether or to what extent Vimpat causes birth defects in humans is not presently known. This indicates that caution is advised, but the benefits of the medication may outweigh the potential risks.

Talk to your doctor or another health professional if you are pregnant or plan to become pregnant. We don't yet have enough information to be able to estimate the risk of various types of birth defects that might occur if Vimpat is taken during pregnancy. We also don't know enough to compare the risk with Vimpat to the risk with other seizure medicines.

The risk of birth defects is generally higher for women who take more than one AED and for women with a family history of birth defects.

Women who are capable of becoming pregnant should take at least 400 micrograms (0.4 mg) of folic acid (folate) daily to help prevent a type of birth defect called a neural tube defect. (The best-known of these is spina bifida, in which the spinal cord is not completely enclosed.) Women at high risk, such as those with a history of this kind of defect in a previous pregnancy, should take 4000 mcg (4 mg) daily, beginning before they become pregnant.

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. The doctor may recommend checking the level of medication in the blood regularly during pregnancy so that the dosage can be adjusted as needed.

How much Vimpat is passed through breast milk is not known for certain, but the way the body uses it suggests that probably a large portion does enter the milk. If you want to breast-feed your baby, check with your doctor about what seizure medicine would be best for you.

What are the effects of Lacosamide on Seniors

Information on use of Vimpat in seniors is very limited at time of release of the drug, but experience will accumulate. Seniors are more susceptible to certain side effects, for example, imbalance and confusion, so caution should be applied.

What are the dose ranges for Lacosamide?

For adults, Vimpat is usually started at 50 milligrams (mg) twice daily. The dosage can be increased to 100 mg twice a day after a week, then 150 mg twice a day for a week, then 200 mg twice a day. Dosage usually would be continued at 200 mg twice a day (400 mg per day total). For people who are particularly prone to medication side effects, the initiation may start more slowly. On the other hand, some patients with an urgent need to control seizures quickly might increase dosage faster than usual. You should plan the medication schedule with your doctor.

Read the package insert of Lacosamide

In the United States, companies that manufacture medicines are required to publish certain kinds of information about each product. This document is commonly known as a “package insert” because it is usually included with each package of the medicine.

You can also read these documents (also called "prescribing information") online. The U.S. package insert for Vimpat (lacosamide) is found at:

Some of the information may differ in other countries.

To learn how to read and understand a package insert, see How to read a package insert.