Abstract
Objective
Lacosamide is a new generation antiepileptic drug (AED) that is eliminated by both hepatic and renal mechanisms. Lacosamide elimination by Continuous Renal Replacement Therapy (CRRT) has never been studied. The objective of this case report was to describe lacosamide pharmacokinetics in the setting of CRRT.
Methods
Case report of a single patient admitted to the study center with status epilepticus and multi-organ failure. The patient required both continuous venovenous hemofiltration (CVVH) and several AEDs. He was receiving intravenous lacosamide 200 mg twice daily at steady state prior to sampling. Plasma lacosamide concentrations were derived using a validated high performance liquid chromatography (HPLC) method. Parameters were calculated using Phoenix WinNonlin 7.1 software.
Results
The peak concentration at steady state was 7.7 mg/L, the trough concentration was 5.9 mg/L (goal 5-12 mg/L). The volume of distribution was 0.7 L/kg, the elimination half-life was 21 h, and the sieving coefficient was 0.8 (± 0.06).
Conclusion
Lacosamide was cleared by CVVH as demonstrated by the sieving coefficient, but plasma concentrations remained within goal range throughout the dosing interval. These results may suggest that lacosamide 200 mg twice daily is a useful dosing strategy for critically ill patients who require CVVH.
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