Key takeaways
Vimpat (lacosamide) is taken for focal or generalized seizures in adults and children.
The drug is manufactured in tablet, oral solution, and intravenous injection formulations.
Depending on the specifics of the seizure disorder being treated, the dose of Vimpat for adults generally starts at 50 to 100 mg twice daily and can be increased to 100 to 200 mg twice daily when necessary.
Dosing for children must take into account age and weight, as well as which variety of epilepsy is present.
The maximum dose of Vimpat is lowered in severe renal and mild to moderate hepatic impairment, and the drug is avoided in severe hepatic impairment.
Vimpat is the brand name of lacosamide, a medication used to treat seizures. It offers a lot of flexibility by being able to be used alone or in tandem with other antiepileptic or anticonvulsant drugs and by having various formulations, including an immediate-release oral tablet, liquid solution, and intravenous (IV) injection. Indications for Vimpat’s use are also wide-ranging, with the Food and Drug Administration (FDA) approving it for focal seizures and primary generalized tonic-clonic seizures in adults and children. Across the spectrum of its use and numerous formulations, Vimpat is dosed differently
, and we will review this topic here.
Vimpat forms and strengths
Tablets: 50 mg, 100 mg, 150 mg, 200 mg
Oral liquid solution: 10 mg/mL
Intravenous solution: 200 mg/20 mL
Vimpat dosage for adults
The FDA has approved Vimpat for use on its own as monotherapy or in conjunction with another anticonvulsant for the treatment of adults with focal seizures. In adults with primary generalized tonic-clonic seizures, Vimpat only has an indication for adjunctive use, meaning it is prescribed alongside an additional seizure med. In both roles for epilepsy management, Vimpat has a dose that is started low and titrated upward.
Vimpat dosage chart |
|||
|---|---|---|---|
| Indication | Starting dosage | Standard dosage | Maximum dosage |
| Focal seizures - monotherapy | 50 to 100 mg tablet, oral solution, or IV twice daily | 150 to 200 mg tablet, oral solution, or IV twice daily | 200 mg tablet, oral solution, or IV twice daily |
| Focal seizures - adjunctive therapy | 50 mg tablet, oral solution, or IV twice daily | 100 to 200 mg tablet, oral solution, or IV twice daily | 200 mg tablet, oral solution, or IV twice daily |
| Primary generalized tonic-clonic seizures - adjunctive therapy | 50 mg tablet, oral solution, or IV twice daily | 100 to 200 mg tablet, oral solution, or IV twice daily | 200 mg tablet, oral solution, or IV twice daily |
Vimpat dosage for focal seizures
Focal seizures begin on one side of the brain, and depending on which area of the brain is affected, they may be associated with shaking of a body part, altered sensation, vision changes, or nausea, among other symptoms. Awareness may or may not be impaired with this seizure type. Focal seizures were formerly called petit mal, partial seizures, or partial-onset seizures.
In the treatment of focal or partial-onset seizures in adults, Vimpat is typically started at a dose of 50 to 100 mg twice daily if used alone or 50 mg twice daily dose if used in conjunction with other antiepileptic drugs. If needed, the dose may then be gradually increased at weekly intervals until reaching a dose of 150 to 200 mg twice daily in monotherapy or 100 to 200 mg twice daily if used as adjunctive therapy.
Vimpat dosage for generalized tonic-clonic seizures
Generalized tonic-clonic seizures originate from both sides of the brain and result in bodily stiffening, jerking movements, and a loss of awareness. These were formerly called grand mal seizures. Vimpat can be used to treat them in tandem with other anticonvulsants. An initial 50 mg twice daily dose is begun and can be gradually increased each week up to 100 to 200 mg twice daily.
Vimpat dosage for children
Children with epilepsy may be prescribed Vimpat. It is approved by the FDA for treating focal seizures in children one month of age and older as monotherapy or as an adjunct and for treating generalized tonic-clonic seizures in children four years of age and older as an adjunct with other anticonvulsants. Dosing for adolescents aged 17 and older is the same as for adults. Under age 17, the dose is based on weight and is referred to as milligrams (mg) of Vimpat per kilogram (kg) of body weight per dose. The Vimpat dosage depends on seizure type as well.
Vimpat dose for focal seizures in children 1 month to 16 years |
||
|---|---|---|
| Weight | Recommended starting dosage (oral solution or tablet) | Recommended maintenance dosage (oral solution or tablet) |
| Less than 6 kg | 1 mg/kg/dose orally twice daily | 3.75 to 7.5 mg/kg/dose orally twice daily |
| 6 to 29 kg | 1 mg/kg/dose orally twice daily | 3 to 6 mg/kg/dose orally twice daily |
| 30 to 49 kg | 1 mg/kg/dose orally twice daily | 2 to 4 mg/kg/dose orally twice daily |
| 50 kg and over | 50 mg orally twice daily | 150 to 200 mg orally twice daily if monotherapy and 100 to 200 mg orally twice if adjunctive therapy |
Vimpat dose for generalized tonic-clonic seizures in children 4 to 16 years |
||
|---|---|---|
| Weight | Recommended starting dosage (oral solution or tablet) | Recommended maintenance dosage (oral solution or tablet) |
| 11 to 29 kg | 1 mg/kg/dose orally twice daily | 3 to 6 mg/kg/dose orally twice daily |
| 30 to 49 kg | 1 mg/kg/dose orally twice daily | 2 to 4 mg/kg/dose orally twice daily |
| 50 kg and over | 50 mg orally twice daily | 100 to 200 mg orally twice if adjunctive therapy |
Vimpat dosage restrictions
To be eliminated from the body, Vimpat is metabolized by the liver and excreted into urine by the kidneys. As a result, dosing should be restricted in those with impaired liver or kidney function. The maximum dose of Vimpat for anyone with a creatinine clearance of less than 30 mL/min or with mild to moderate liver impairment is typically only 75% of the standard maximum dose. Vimpat is generally avoided in people with severe liver impairment.
How to take Vimpat
Most importantly, Vimpat is taken on a regular schedule, twice daily. It can be taken with or without food, but the tablets should not be cut. Taking Vimpat correctly is vital to maximizing its effectiveness.
Take your medicine as directed. The dose may need to be changed several times, so always check the strength of the tablets to make sure they match the prescription.
Vimpat can be taken with or without food.
Do not stop taking Vimpat until consulting with the prescriber.
How to take Vimpat tablets:
Swallow the tablet whole with a glass of water. Do not crush, break, or chew it.
Store Vimpat tablets at room temperature.
How to take Vimpat oral solution:
Measure each dose with a medicine cup or medicine dropper. Do not use kitchen measuring devices or tableware.
The oral solution can be given through a feeding tube if necessary.
Store Vimpat oral solution at room temperature. Do not freeze.
The oral solution is good for six months. After that, throw away the bottle and any remaining medicine.
Vimpat dosage FAQs
Vimpat vs. Motpoly XR: What’s the difference in doses?
Motpoly XR is a brand-name, extended-release form of lacosamide. It permits adults and children who are at least 17 years of age or who weigh at least 50 kg to take their recommended starting dose or maintenance dose in a consolidated once daily format. Compared to Vimpat, Motpoly XR is available in 100 mg, 150 mg, and 200 mg capsules.
Motpoly XR capsules are only available as a brand-name product, while generic lacosamide is an alternative to Vimpat. If the price of these products is a concern, a SingleCare discount card can help.
How long does it take Vimpat to work?
Following an oral dose, Vimpat is well absorbed and reaches peak levels in the bloodstream within 4 hours. The dose can be gradually titrated upward over a matter of weeks, if needed, to a maintenance dose that is fully effective. If an adult’s dose is increased each week by 50 mg twice daily, then the maximum dose would usually be reached in one to three weeks. Alternatively, to possibly gain quicker control of seizures, a loading dose is given as a single higher dose to start with; this is sometimes recommended by neurologists.
How long does Vimpat stay in your system?
The half-life of Vimpat is about 13 hours in adults, meaning that half of the Vimpat level in the body is eliminated within 13 hours after a dose. This means that about 97% of it would be eliminated within 65 hours following the last dose.
What happens if I miss a dose of Vimpat?
Your neurologist should give you instructions on what to do if a dose of seizure medication is missed. Typically, the forgotten dose is taken as soon as it is remembered unless the following dose is nearly due, in which case the forgotten dose is not taken. Taking two doses at the same time is generally not advised due to concern about side effects.
How long can you take Vimpat?
Vimpat treatment is not time-limited. It can be taken as long as it is necessary, effective, and well-tolerated, provided there is medical supervision.
How do I stop taking Vimpat?
Before stopping Vimpat, you need to discuss this in detail with your doctor. The reasons for discontinuing the drug must be examined. Then, if Vimpat is to be stopped, a gradual taper may be planned to lessen the risk of seizure episodes.
What is the maximum dosage for Vimpat?
The maximum daily dose for adults is usually listed as 400 mg. Although higher doses have sometimes been used, adverse reactions can be more problematic.
Can you overdose on Vimpat?
Unfortunately, overdoses of Vimpat can be quite dangerous. Dizziness, nausea, confusion, and seizures can occur. Cardiac arrhythmias, cardiac arrest, and coma are also possible. If an overdose occurs, get emergency medical attention and call Poison Control at 1-800-222-1222.
What interacts with Vimpat?
Vimpat can interact with numerous other medications. Its tendency to alter electrical cardiac conduction means that combining it with drugs that affect heart rate or rhythm, such as antiarrhythmics, can be risky. Likewise, Vimpat’s ability to cause drowsiness and sedation can be heightened by other meds that do so, such as mental health medicine and other antiepileptic drugs. Ask your pharmacist and Vimpat prescriber to review your list of prescription medications, over-the-counter drugs, and supplements to look for hazardous drug interactions.
What happens when you mix Vimpat and alcohol?
Alcohol is a central nervous system depressant, meaning it can cause drowsiness and imbalance. Vimpat can have these same adverse effects, and the two together can magnify the risks. No safe amount has been defined, so your healthcare provider may recommend avoiding alcohol while taking Vimpat.
Is it safe to take Vimpat during pregnancy?
Taking Vimpat during pregnancy may be beneficial for seizure control, but it may be risky to fetal health. The risks have not been determined or defined. On a case-by-case basis, it is up to neurologists, obstetricians, and patients to discuss the benefits and risks to determine if the drug should be continued or not.
Sources
Vimpat drug label
, NIH DailyMed (2024)Focal aware seizures
, Epilepsy Foundation (2024)Tonic-clonic seizures
, Epilepsy Foundation (2024)
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