Vosamide Dosage/Direction for Use

Monotherapy: Initial and titration dosage: 100 mg orally twice daily (200 mg/day); may be increased to 150 mg twice daily (300 mg/day) after one week. The dose can be further increased up to a maximum recommended maintenance daily dose of 200 mg twice daily (400 mg/day) based on response and tolerability.
Converting from another single antiepileptic: After lacosamide has titrated to therapeutic dosage for at least 3 days, may begin gradual withdrawal of the other antiepileptic over at least 6 weeks.
Adjunctive therapy: Initial and titration dosage: 50 mg orally twice daily (100 mg/day); may be increased to 100 mg twice daily (200 mg/day) after one week. The dose can be further increased by 50 mg twice daily every week, to a maximum recommended maintenance daily dose of 200 mg twice daily (400 mg/day) based on response and tolerability.
Initial treatment with a loading dose: Single loading dose of 200 mg followed approximately 12 hours later by 100 mg twice daily for 1 week; may be increased at weekly intervals by 50 mg twice daily based on response and tolerability.
Administer loading doses under medical supervision because of the increased incidence of CNS adverse reactions.
Discontinuation of therapy: In patients receiving lacosamide long term, unless safety concerns require a more rapid withdrawal, lacosamide should be withdrawn gradually over a few weeks to several months to minimize the potential of seizures or other withdrawal symptoms.
Renal impairment: Mild to moderate impairment (CrCl more than 30 mL/min): No dosage adjustment is necessary. Cautiously titrate dosage.
Severe impairment (CrCl less than or equal to 30 mL/min) or ESRD: Maximum dosage is 250 mg/day.
For patients requiring haemodialysis, a supplement of up to 50% of the divided daily doses directly after the end of haemodialysis is recommended.
Renal impairment and taking a concomitant strong inhibitor of CYP3A4 or CYP2C9: Dose reduction may be necessary.
Hepatic impairment: Mild to moderate impairment: Titrate dose cautiously.
Maximum dose is 300 mg/day.
Severe impairment: Use is not recommended.
Hepatic impairment and taking a concomitant strong inhibitor of CYP3A4 or CYP2C9: Dose reduction may be necessary.
Elderly (over 65 years of age): No dosage reduction is necessary in elderly patients. Age associated decreased renal clearance with an increase in AUC levels should be considered in elderly patients.
Pediatric: The safety and efficacy of lacosamide in children aged below 16 years have not yet been established.
Administration: VOSAMIDE must be taken twice a day (usually once in the morning and once in the evening).
May be administered with or without food. Swallow tablets whole, do not divide.