Intravenous lacosamide for seizures well tolerated in children, infants

Treating seizures with intravenous lacosamide appears to be safe and is associated with low rates of adverse events (AEs) among critically ill children and neonates, as reported in a study.

In this retrospective multicentre cohort study, researchers evaluated the safety of intravenous lacosamide use in 686 and 28 hospitalized children and neonates, respectively, who received care.

AEs attributed to lacosamide were documented in only 10 children (1.5 percent). AEs included rash (n=3, 0.4 percent), somnolence (n=2, 0.3 percent), and bradycardia, prolonged QT interval, pancreatitis, vomiting, and nystagmus (n=1, 0.1 percent each). No AEs attributed to lacosamide were recorded in the neonates.

Across the entire cohort, treatment-emergent AEs documented in >1 percent of patients included rash, bradycardia, somnolence, tachycardia, vomiting, feeling agitated, cardiac arrest, tachyarrhythmia, low blood pressure, hypertension, decreased appetite, diarrhoea, delirium, and gait disturbance.

None of the children and neonates had PR interval prolongation or severe cutaneous adverse reactions.

Compared with children who received a recommended initial dose of intravenous lacosamide, those who received a higher-than-recommended initial dose had a twofold increase in the risk of rash (adjusted incidence rate ratio, 2.11, 95 percent confidence interval, 1.02–4.38).

More studies are needed to look at dose-dependent AEs in children, the safety profile and efficacy of lacosamide in the setting of acute neurologic injury, and the effectiveness of intravenous lacosamide used earlier in neonatal seizure treatment.