A Case of Suspected Lacosamide-induced Paroxysmal Atrial Fibrillation and Bradycardia-tachycardia Syndrome and Utilization of Therapeutic Drug Monitoring

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  • ラコサミドによる発作性心房細動及び徐脈頻脈症候群が疑われた一症例とTDMの活用

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Abstract

Lacosamide (LCM) is an anticonvulsant drug that stabilizes hyperexcitable neuronal membranes by selectively promoting the slow inactivation of voltage-gated sodium channels. Therapeutic drug monitoring (TDM) is not commonly performed for LCM, because a therapeutic concentration range has not yet been established. We report a case of a 61-year-old man under treatment with 300 mg/day of LCM, who was rushed to the emergency room with epileptic seizure disorder. The patient developed paroxysmal atrial fibrillation and bradycardia-tachycardia syndrome during treatment. A pharmacist in charge of the ward analyzed his plasma LCM concentrations according to expected PK parameters. Since the incidence of adverse events increases with increasing plasma LCM concentrations, dosage for a patient with impaired renal function should be adjusted to compensate for the expected decrease in total clearance, or the predicted elevated plasma concentrations. Clinical trial results may be used as a reference for plasma concentrations. Performing TDM is recommended, since the knowledge of plasma concentrations of individual LCMs with confirmed efficacy and tolerability may be useful for dose adjustment during pharmacokinetic changes.

Journal

  • Applied Therapeutics

    Applied Therapeutics 16 (0), 44-52, 2021

    Japanese Society for Applied Therapeutics

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