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American Journal of Public Health Research
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The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
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The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
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Clinical and Histological Features in Wegener Granulomatosis
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Anne Lanham, Lillian Mwanri

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Lacosamide Induced Bradycardia

Mohamedanwar Ghandour*, Heba Osman, Samer Alkassis, Yahya Osman-Malik, Zeenat Y. Bhat

Department of Internal Medicine, Nephrology Division, Wayne State University/Detroit medical Center, Michigan, USA

Abstract: Lacosamide (LCM)is an anti-epileptic drug associated with a serious cardiac event. Herein, we report a case of a 45-year-old male patient with lacosamide induced-bradycardia.

Keywords: Lacosamide, bradycardia

Received November 16, 2020; Revised December 21, 2020; Accepted January 04, 2021

Citation: Mohamedanwar Ghandour, Heba Osman, Samer Alkassis, Yahya Osman-Malik, Zeenat Y. Bhat, Lacosamide Induced Bradycardia. American Journal of Medical Case Reports, 9 (3). 153-154. January 2021. doi:10.12691/ajmcr-9-3-5

1. Introduction

Lacosamide (LCM)is an anti-epileptic drug which acts mainly through enhancing the slow inactivation of voltage-dependent sodium channels [1]. It was approved initially, in 2008, by the U.S. Food and Drug Administration (FDA). However, Lacosamide is associated with a serious cardiac conduction disturbance [2,3]. Herein, we report a case of sinus bradycardia associated with lacosamide therapy.

2. Case Presentation

Our 45-year-old male patient with anoxic brain injury dependent on tracheostomy, and history of seizure disorder who was admitted for septic shock secondary to ventilator associated pneumonia. Patient also presented with acute kidney injury (AKI) secondary to obstructive uropathy which improved with Foley catheter replacement. IV fluids were administered, norepinephrine and vasopressin drips were started due to shock. Patient was given broad-spectrum antibiotics, including meropenem and vancomycin, due to his history of multidrug resistant bacteremia. On the second day of admission, bradycardia was noted on the monitor with the lowest being in the 40s per minute despite being on norepinephrine. Patient's acidemia did resolve before this episode with broad-spectrum antibiotic and aggressive hydration. There was no change in the patient's medication regimen, and he was not on sedation or opioids. No electrolyte abnormalities were noted at the time of the episode. For his seizure disorder, patient takes levetiracetam 1500 mg and lacosamide 200 mg twice daily. Neurology service was consulted for bilateral upper extremity twitching with concern due to seizure-like activity which was ruled out by electroencephalogram. However, lacosamide toxicity was suspected as a cause of bradycardia as patient developed AKI and LCM were not able to be excreted. However, following renal function recovery, it resulted in significant improvement of heart rate.

3. Discussion

Several adverse cardiac events have been reported with LCM. Mild events include dose-dependent PR interval pro-longation [4,6,7] and first-degree AV block [4,5,6]. More serious events include atrial fibrillation/flutter at relatively high dosages of LCM at 600 mg/day [2,4]. Single fatal cardiac arrests reported in each of two clinical studies of LCM in patients with diabetic neuropathy [4,7] were thought to be due to coronary artery disease. An instance of second-degree AV block observed in one study in a patient taking 600 mg/day of LCM [4], but a clear causal relation could not be established as that observation was made 5 days after the last dosage of LCM, with resolution on a subsequent visit. A case of transient third-degree AV block was recently reported in a patient with cardiac disease after high doses of LCM were given intravenously for nonconvulsive status epilepticus [6].

The reported case had a sinus bradycardia which improved with decreasing LCM dose.

In Summary, Lacosamide is associated with a serious cardiac event, cautious use and dose adjustment is needed when patient develops unexplained bradycardia. Moreover, baseline Electrocardiographic before and during LCM therapy may useful to avoid cardiac arrhythmias.

References

[1]   | Kellinghaus C. (2009). Lacosamide as treatment for partial epilepsy: mechanisms of action, pharmacology, effects, and safety. Ther Clin Risk Manag 5: 757-766.
[2]   | Degiorgio CM. (2010) Atrial flutter/atrial fibrillation associated with lacosamide for partial seizures. Epilepsy Behav 18: 322-324.
[3]   | Nizam A, Mylavarapu K, Thomas D, Briskin K, Wu B, Saluja D, Wong S. (2011) Lacosamide‐induced second‐degree atrioventricular block in a patient with partial epilepsy. Epilepsia 52: e153-e155.
[4]   | Shaibani A, Fares S, Selam JL, Arslanian A, Simpson J, Sen D, Bongardt S. (2009). Lacosamide in painful diabetic neuropathy: an 18‐week doubleblind placebo‐controlled trial. J Pain 10: 818-828.
[5]   | Ben‐Menachem E, Biton V, Jatuzis D, Abou‐Khalil B, Doty P, Rudd GD. (2007) Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial‐onset seizures. Epilepsia 48: 1308-1317.
[6]   | Krause LU, Brodowski KO, Kellinghaus C. (2011) Atrioventricular block following lacosamide intoxication. Epilepsy Behav 20: 725-727.
[7]   | Wymer JP, Simpson J, Sen D, Bongardt S. (2009) Efficacy and safety of lacosamide in diabetic neuropathic pain: an 18‐week double‐blind placebo‐controlled trial of fixed‐dose regimens. Clin J Pain 25: 376-385.