NSTK · 01.2026Independent supplement reference
NutriStack
Edition 1.0Reviewed May 26, 2026

Lacosamide

Prescription ·Strong evidence ·Reviewed May 2026

Lacosamide is an antiseizure medication used for focal-onset seizures and primary generalized tonic-clonic seizures in appropriate patients. Its signature safety concern is dose-dependent PR-interval prolongation, which can worsen atrioventricular block or bradyarrhythmias in susceptible patients. It is a Schedule V controlled substance in the United States.

Evidence tier
Strong
Indexed sources
3 2007–2025
Interactions
4
Category
Prescription
Read the sources → Compare profiles
What it's good for
  • Monotherapy or adjunctive treatment of focal-onset seizures1,2
  • Adjunctive treatment of primary generalized tonic-clonic seizures in labeled populations3,1
  • Oral and intravenous formulations allow inpatient transitions1
What to watch for
  • Dizziness
  • Headache
  • Diplopia
  • None listed in some US labeling; avoid use after serious hypersensitivity to lacosamide3
  • Use caution with second- or third-degree AV block, sick sinus syndrome without pacemaker, severe cardiac disease, or concomitant PR-prolonging drugs2

The bottom line

Evidence rating strong. Most-documented uses: monotherapy or adjunctive treatment of focal-onset seizures, adjunctive treatment of primary generalized tonic-clonic seizures in labeled populations, oral and intravenous formulations allow inpatient transitions. 3 sources indexed (2007–2025), with 4 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Lacosamide selectively enhances slow inactivation of voltage-gated sodium channels, stabilizing hyperexcitable neuronal membranes without substantially affecting fast sodium-channel inactivation. This reduces repetitive neuronal firing and seizure propagation. It can prolong cardiac PR interval, so patients with conduction disease or other PR-prolonging drugs need ECG-focused caution.1,2

Class
Anticonvulsant sodium-channel modulator
Dosing

Dosing & protocol.

Common range
Adjunctive therapy often starts at 50 mg twice daily; monotherapy may start at 100 mg twice daily. Usual maintenance is 100-200 mg twice daily; maximum recommended dose is 200 mg twice daily.
Recommended form
Oral tablet, oral solution, or intravenous infusion; extended-release capsule for selected patients

May be taken with or without food. Oral bioavailability is high, and IV can substitute when oral dosing is temporarily not feasible.

Safety

Full safety detail.

Side effects

  • Dizziness
  • Headache
  • Diplopia
  • Nausea
  • Somnolence
  • Ataxia
  • PR interval prolongation
  • Atrioventricular block or bradyarrhythmia in susceptible patients
  • Syncope
  • DRESS or multiorgan hypersensitivity
  • Suicidal thoughts or behavior warning for antiepileptic drugs

Contraindications

  • None listed in some US labeling; avoid use after serious hypersensitivity to lacosamide3
  • Use caution with second- or third-degree AV block, sick sinus syndrome without pacemaker, severe cardiac disease, or concomitant PR-prolonging drugs2
Interactions

Interaction records.

ModerateCaution

Ginkgo Biloba

Ginkgo has seizure case reports and may undermine antiseizure therapy.

Recommendation: Avoid ginkgo in epilepsy unless approved by the neurologist.

ModerateCaution

Melatonin

Melatonin can add to lacosamide-related dizziness and somnolence.

Recommendation: Use cautiously and monitor alertness and balance.

ModerateCaution

L-Theanine

L-Theanine may add calming effects to lacosamide-related somnolence or dizziness.

Recommendation: Use cautiously during titration or if already dizzy.

InfoCaution

Magnesium Glycinate

Usual magnesium doses are not a direct problem, but very high magnesium exposure in renal impairment can worsen weakness or cardiac conduction concerns.

Recommendation: Use standard doses only; avoid high-dose magnesium without clinician guidance in renal disease or known AV block.

Search all 4 interaction records for Lacosamide →

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Randomized controlled trials

1
  • 1Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizuresNeeds reviewNo linkBen-Menachem E et al. · Epilepsia · 2007

    Randomized trial evidence supports lacosamide efficacy as adjunctive therapy for partial-onset seizures.

Reviews & position papers

1
  • 2Lacosamide: a review of its use as adjunctive therapy in the management of partial-onset seizuresNeeds reviewNo linkHoy SM · CNS Drugs · 2013

    Review summarizes clinical efficacy, tolerability, and conduction-related cautions.

Reference material

1
  • 3LACOSAMIDE tablets, US Prescribing InformationNeeds reviewURLU.S. National Library of Medicine · DailyMed · 2025

    Labeling describes dosing, Schedule V status, PR interval warning, ECG recommendations in high-risk patients, and 13-hour half-life.

Keep exploring

Deep dives & adjacent profiles.

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This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.

Use this with your stack

Lacosamide in NutriStack.

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NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.