Lacosamide dosing in patients receiving continuous renal replacement therapy

Last modified: November 14, 2023
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Research Article: Lacosamide dosing in patients receiving continuous renal replacement therapy
Author: Weerachai Chaijamorn, Sathian Phunpon, Thanompong Sathienluckana, Taniya Charoensareerat, Sutthiporn Pattharachayakul, Dhakrit Rungkitwattanakul and Nattachai Srisawat
Email: sathian.phu@siam.edu ; thanompong.sat@siam.edu ; taniya.cha@siam.edu
Department|Faculty: Faculty of Pharmacy,  Siam University, Bangkok 10160
Published: Journal of Intensive Care, Volume 11, Issue 50, pages 1-9.

Citation

Chaijamorn W, Phunpon S, Sathienluckana T, Charoensareerat T, Pattharachayakul S, Rungkitwattanakul D and Srisawat N. (2023). Lacosamide dosing in patients receiving continuous renal replacement therapy. Journal of Intensive Care, 11(50), 1-9. https://doi.org/10.1186/s40560-023-00700-4


ABSTRACT

Background : Lacosamide is one of the anticonvulsants used in critically ill patients. This study aimed to suggest appropriate lacosamide dosing regimens in critically ill patients receiving continuous renal replacement therapy (CRRT) via Monte Carlo simulations. Methods : Mathematical models were created using published demographic and pharmacokinetics in adult critically ill patients. CRRT modalities with diferent efuent rates were added into the models. Lacosamide regimens were evaluated on the probability of target attainment (PTA) using pharmacodynamic targets of trough concentrations and area under the curve within a range of 5–10 mg/L and 80.25–143 and 143–231 mg*h/L for the initial 72 h-ther-apy, respectively. Optimal regimens were defned from regimens that yielded the highest PTA. Each dosing regimen was tested in a group of diferent 10,000 virtual patients. Results : Our results revealed the optimal lacosamide dosing regimen of 300–450 mg/day is recommended for adult patients receiving both CRRT modalities with 20–25 efuent rates. The dose of 600 mg/day was suggested in higher efuent rate of 35 mL/kg/h. Moreover, a patient with body weight>100 kg was less likely to attain the targets. Conclusions : Volume of distribution, total clearance, CRRT clearance and body weight were signifcantly contributed to lacosamide dosing. Clinical validation of the fnding is strongly indicated.

Keywords:  Lacosamide, Pharmacokinetics, Drug dosing, Critically ill patients, Continuous renal replacement therapy.


Lacosamide dosing in patients receiving continuous renal replacement therapy

Faculty of Pharmacy, Siam University, Bangkok, Thailand

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