Page 43 - AN-2-2

Advanced Neurology Seizures and CKD

Dialysis‑related dose adjustments US: 50% daily dose as post-HD supplementation UK: No additional dosing adjustments recommended Dialysis‑related dose adjustments US: Consider post-HD supplementation dose. Evidence remains not fully clear UK: Evidence not fully clear. Does not recommend additional post-HD supplementation dosing at present

eGFR (mL/min/1.73 m 2 ) related dose adjustments US: No dosing adjustments needed for eGFR GF30. Maximum 300 mg daily with slow titration for eGFR < 30 UK: No dosing adjustments needed for eGFR ≥ 30. Upper limit of dosing to be 250 mg daily for patients with eGFR < 30 eGFR (mL/min/1.73 m 2 ) related dose adjustments US: Dosing reduction for eGFR < 60 may be needed. Advice to prescribe with caution UK: Advise to

Potential nephrotoxicities Only a single reported case of nephritis Potential nephrotoxicities Interstitial nephritis with antiepileptic hypersensitivity syndrome

Interactions with other AEDs Reduces 10-hydroxycarbozepine levels Interactions with other AEDs Reduces clonazepam, levetiracetam and valproic acid levels Lamotrigine levels could be increased by valproic acid

% of urinary excretion Approximately 95% AED: Antiepileptic drug; CYP450: Cytochrome P450; eGFR: estimated glomerular filtration rate; HD: Hemodialysis; UK: United Kingdom; US: United States % of urinary excretion Approximately 10% AED: Antiepileptic drug; eGFR: estimated glomerular filtration rate; GABA: Gamma-aminobutyric acid; HD: Hemodialysis; UK: United Kingdom; US: United States

Metabolism Hepatic metabolism through CYP450 system Metabolism Hepatic metabolism

Protein binding <15% Protein binding Between 50% and 55%
Table 10. Properties and metabolism of lacosamide

Primary mechanism of action Inactivation of slow voltage-gated sodium channels, whilst not interfering with fast inactivation Table 11. Properties and metabolism of lamotrigine Primary mechanism of action Blockade of voltage-gated sodium channels, reduction of glutamate, enhancement of GABA release

AED (reference range in mg/L) Lacosamide [9,130,131,135,160-162] (10 – 20) AED (reference range in mg/L) Lamotrigine [9,130,131,135,139,163-165] (2.5 – 15)

17
https://doi.org/10.36922/an.314
Volume 2 Issue 2 (2023) olume 2 Issue 2 (2023)
V 17 https://doi.org/10.36922/an.314