Generic Name

Nayzilam (lacosamide)

Drug Class

Antiepileptic – selective sodium‑channel modulator

Mechanism

Augments slow inactivation of voltage‑gated Na⁺ channels → reduces high‑frequency repetitive firing of neurons. Does not affect fast inactivation nor other ion channels [1].

Pharmacokinetics

• Oral bioavailability ≈93 % (rapid absorption).
• Tmax 1–2 h.
• Protein binding ~25 % (low).
• Metabolism: minimal CYP involvement; mainly hydrolysis to inactive metabolites [2].
• Half‑life ≈13–16 h; dose‑adjustable by linear kinetics.
• Excretion: primarily renal (≈96 % unchanged); ∼4 % as metabolites.

Indications

Adjunctive treatment of partial‑onset seizures (with or without secondary generalization) in adults and children ≥12 yrs; adjunctive therapy for focal seizures in patients ≥4 yrs + ≥10 kg (EMA).

Contraindications

• Hypersensitivity to lacosamide or any excipients.
• Known severe hepatic impairment (experienced in clinical setting).

Adverse Effects

• Common (≥10 %): dizziness, paresthesias, headache, nausea, fatigue.
• Serious: bradyarrhythmia, conduction block, syncope, severe headache, rash → possible Stevens–Johnson.
• Pregnancy: Category D; use only if benefits outweigh risks.

Clinical Pearls

• Renal impairment: no dose adjustment needed; monitor plasma levels if ≥90 % CrCl