Issues for surgery
Precipitation of rebound seizures or status epilepticus if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Patients should be advised to take their regular medications on the day of surgery.
Abrupt withdrawal of any anticonvulsant drug should be avoided.
Confirm with the patient if they need to be maintained on a specific manufacturer’s product (see Further information).
Post-operative advice
Regular dosing of the patient’s usual oral medication should be re-established as early as possible post-operatively.
If patients are unable to take their regular oral medication post-operatively, consider using the intravenous route. The intravenous dose and frequency should be the same as the established oral dose.
Interactions with common anaesthetic agents
None.
For general information regarding the use of anaesthetic agents in epilepsy patients see Antiepileptics overview.
Interactions with other common medicines used in the perioperative period
For general information regarding the use of antiemetics in epilepsy patients see Antiepileptics overview.
Antimicrobials
Clarithromycin is predicted to increase the plasma concentration of lacosamide (due to its potential to inhibit CYP3A4). Bear in mind the theoretical potential for an interaction should an increase in lacosamide adverse effects (such as nausea, dizziness, diplopia) occur. Consider reducing the lacosamide dose in patients with hepatic or renal impairment.
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring. Consult current product literature.
Further information
MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products (November 2017)
Lacosamide is a category 3 antiepileptic, hence it is usually unnecessary to ensure that patients are maintained on a specific manufacturer’s product as therapeutic equivalence can be assumed. However, other factors are important when considering if switching is appropriate such as patient anxiety, risk of confusion or dosing errors. For more information see Antiepileptics overview.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed 3rd July 2019]
Perks A, Cheema S, Mohanraj R. Anaesthesia and epilepsy BJA: British Journal of Anaesthesia. 2012; 108(4):562-571
Carter EL, Adapa RM. Adult epilepsy and anaesthesia. BJA Education. 2015; 15(3):111-117
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 19th July 2019]
Summary of Product Characteristics – Vimpat® (lacosamide) film-coated tablets. UCB Pharma Limited. Accessed via www.medicines.org.uk 18/07/2019 [date of revision of the text September 2018]