Label: LACOSAMIDE tablet, film coated
LACOSAMIDE tablet

  • NDC Code(s): 31722-812-05, 31722-812-18, 31722-812-32, 31722-812-60, view more
    31722-813-05, 31722-813-18, 31722-813-32, 31722-813-60, 31722-814-05, 31722-814-18, 31722-814-32, 31722-814-60, 31722-815-05, 31722-815-18, 31722-815-32, 31722-815-60
  • Packager: Camber Pharmaceuticals, Inc.
  • Category: HUMAN PRESCRIPTION DRUG LABEL
  • DEA Schedule: CV
  • Marketing Status: Abbreviated New Drug Application

Drug Label Information

Updated March 16, 2022

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  • HIGHLIGHTS OF PRESCRIBING INFORMATION
    These highlights do not include all the information needed to use LACOSAMIDE TABLETS safely and effectively. See full prescribing information for LACOSAMIDE TABLETS.



    LACOSAMIDE film coated tablets, for oral use, CV

    Initial U.S. Approval: 2008

    RECENT MAJOR CHANGES

    Indications and Usage ( 1.1)                                                            10/2021
    Dosage and Administration ( 2.1, 2.5)                                             10/2021
    Warnings and Precautions ( 5.2)                                                     11/2020

    INDICATIONS AND USAGE


    Lacosamide tablet is indicated for: 
    • Treatment of partial-onset seizures in patients 4 years of age and older ( 1.1)

    DOSAGE AND ADMINISTRATION


    •  Adults (17 years and older):
         o     Initial dosage for monotherapy for the treatment of partial-onset seizures is 100 mg twice daily ( 2.1)
         o     Initial dosage for adjunctive therapy for the treatment of partial-onset seizures is 50 mg twice daily ( 2.1)
         o     Maximum recommended dosage for monotherapy and adjunctive therapy is 200 mg twice daily ( 2.1)
      Pediatric Patients 4 years to less than 17 years: The recommended dosage is based on body weight and is administered orally twice daily ( 2.1)
    •  Increase dosage based on clinical response and tolerability, no more frequently than once per week ( 2.1
    •  Dose adjustment is recommended for severe renal impairment ( 2.3, 12.3
    •  Dose adjustment is recommended for mild or moderate hepatic impairment; use in patients with severe hepatic impairment is not recommended ( 2.4, 12.3


    DOSAGE FORMS AND STRENGTHS


    • 50 mg, 100 mg, 150 mg, 200 mg tablets ( 3)

    CONTRAINDICATIONS


    • None ( 4)


    WARNINGS AND PRECAUTIONS


    • Monitor patients for suicidal behavior and ideation ( 5.1)
    • Lacosamide may cause dizziness and ataxia ( 5.2)
    • Cardiac Rhythm and Conduction Abnormalities: Obtaining ECG before beginning and after titration to steady-state maintenance is recommended in patients with underlying proarrhythmic conditions or on concomitant medications that affect cardiac conduction; closely monitor these patients ( 5.3, 7.2
    • Lacosamide may cause syncope ( 5.4)
    • Lacosamide should be gradually withdrawn to minimize the potential of increased seizure frequency ( 5.5)
    • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multi-Organ Hypersensitivity: Discontinue if no alternate etiology ( 5.6


    ADVERSE REACTIONS


    •  Adjunctive therapy: Most common adverse reactions in adults (≥10% and greater than placebo) are diplopia, headache, dizziness, nausea, and somnolence ( 6.1)
    •  Monotherapy: Most common adverse reactions are similar to those seen in adjunctive therapy studies ( 6.1
    •  Pediatric patients: Adverse reactions are similar to those seen in adult patients ( 6.1
    To report SUSPECTED ADVERSE REACTIONS, contact Annora Pharma Private Limited at 1-866-495-1995 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

    USE IN SPECIFIC POPULATIONS


    •  Pregnancy: Based on animal data, may cause fetal harm ( 8.1)
                                                                                     

    See 17 for PATIENT COUNSELING INFORMATION and Medication Guide.

    Revised: 3/2022

  • Table of Contents

    FULL PRESCRIBING INFORMATION: CONTENTS*

    1 INDICATIONS AND USAGE

    1.1 Partial-Onset Seizures

    2 DOSAGE AND ADMINISTRATION

    2.1 Dosage Information

    2.2 Converting From a Single Antiepileptic (AED) to Lacosamide Tablets Monotherapy for the Treatment of Partial-Onset Seizures

    2.3 Dosage Information for Patients with Renal Impairment

    2.4 Dosage Information for Patients with Hepatic Impairment

    2.5 Administration Instructions for Lacosamide Tablets

    2.7 Discontinuation of Lacosamide Tablets

    3 DOSAGE FORMS AND STRENGTHS

    4 CONTRAINDICATIONS

    5 WARNINGS AND PRECAUTIONS

    5.1 Suicidal Behavior and Ideation

    5.2 Dizziness and Ataxia

    5.3 Cardiac Rhythm and Conduction Abnormalities

    5.4 Syncope

    5.5 Withdrawal of Antiepileptic Drugs (AEDs)

    5.6 Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multi-Organ Hypersensitivity

    6 ADVERSE REACTIONS

    6.1 Clinical Trials Experience

    6.2 Postmarketing Experience

    7 DRUG INTERACTIONS

    7.1 Strong CYP3A4 or CYP2C9 Inhibitors

    7.2 Concomitant Medications that Affect Cardiac Conduction

    8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    8.2 Lactation

    8.4 Pediatric Use

    8.5 Geriatric Use

    8.6 Renal Impairment

    8.7 Hepatic Impairment

    9 DRUG ABUSE AND DEPENDENCE

    9.1 Controlled Substance

    9.2 Abuse

    9.3 Dependence

    10 OVERDOSAGE

    11 DESCRIPTION

    11.1 Lacosamide Tablets, USP

    12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    12.2 Pharmacodynamics

    12.3 Pharmacokinetics

    13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

    14 CLINICAL STUDIES

    14.1 Monotherapy in Patients with Partial-Onset Seizures

    14.2 Adjunctive Therapy in Patients with Partial-Onset Seizures

    16 HOW SUPPLIED/STORAGE AND HANDLING

    16.1 How Supplied

    16.2 Storage and Handling

    17 PATIENT COUNSELING INFORMATION

    *
    Sections or subsections omitted from the full prescribing information are not listed.
  • 1 INDICATIONS AND USAGE

    1.1 Partial-Onset Seizures


    Lacosamide tablet is indicated for the treatment of partial-onset seizures in patients 4 years of age and older.
    Additional pediatric use information is approved for UCB, Inc.'s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

  • 2 DOSAGE AND ADMINISTRATION

    2.1 Dosage Information


    The recommended dosage for monotherapy and adjunctive therapy for partial-onset seizures in patients 4 years of age and older is included in Table 1. In pediatric patients, the recommended dosing regimen is dependent upon body weight. Dosage should be increased based on clinical response and tolerability, no more frequently than once per week. Titration increments should not exceed those shown in Table 1.
    Table 1: Recommended Dosage for Partial-Onset Seizures (Monotherapy or Adjunctive Therapy) in Patients 4 Years of Age and Older*


    Age and Body Weight
     
    Initial Dosage
    Titration Regimen
    Maintenance Dosage
    Adults (17 years and older)
    Monotherapy**: 100 mg twice daily (200 mg per day)
    Adjunctive Therapy: 50 mg twice daily (100 mg per day)
    Increase by 50 mg twice daily (100 mg per day) every week
    Monotherapy**: 150 mg to 200 mg twice daily (300 mg to 400 mg per day)
    Adjunctive Therapy: 100 mg to 200 mg twice daily (200 mg to 400 mg per day)
     
    Alternate Initial Dosage: 200 mg single loading dose, followed 12 hours later by 100 mg twice daily
    Pediatric patients weighing 50 kg or more
     
    50 mg twice daily (100 mg per day)
     
    Increase by 50 mg twice daily (100 mg per day) every week
     
    Monotherapy**: 150 mg to 200 mg twice daily (300 mg to 400 mg per day)
    Adjunctive Therapy: 100 mg to 200 mg twice daily (200 mg to 400 mg per day)
    Pediatric patients weighing 30 kg to less than 50 kg

    1 mg/kg twice daily (2 mg/kg/day)  
    Increase by 1 mg/kg twice daily (2 mg/kg/day) every week
    2 mg/kg to 4 mg/kg twice daily (4 mg/kg/day to 8 mg/kg/day)
    Pediatric patients weighing 11 kg to less than 30 kg

    1 mg/kg twice daily(2 mg/kg/day) 
    Increase by 1 mg/kg twice daily (2 mg/kg/day) every week
    3 mg/kg to 6 mg/kg twice daily (6 mg/kg/day to 12 mg/kg/day)

    *when not specified, the dosage is the same for monotherapy for partial-onset seizures and adjunctive therapy for partial-onset seizures.
    **Monotherapy  for partial-onset seizures only
    In adjunctive clinical trials in adult patients with partial-onset seizures, a dosage higher than 200 mg twice daily (400 mg per day) was not more effective and was associated with a substantially higher rate of adverse reactions [see Adverse Reactions ( 6.1) and Clinical Studies ( 14.2)]. 
    Loading Dose in Adult Patients (17 Years and Older)

    Lacosamide tablets may be initiated in adult patients with a single loading dose of 200 mg, followed approximately 12 hours later by 100 mg twice daily (200 mg per day). The maintenance dose regimen should be continued for one week. Lacosamide tablets can then be titrated as recommended in Table 1. The adult loading dose should be administered with medical supervision because of the increased incidence of CNS adverse reactions [ see Adverse Reactions ( 6.1) and Clinical Pharmacology ( 12.3) ]. 
    The use of a loading dose in pediatric patients has not been studied.

    Additional pediatric use information is approved for UCB, Inc.'s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information. 


    2.2 Converting From a Single Antiepileptic (AED) to Lacosamide Tablets Monotherapy for the Treatment of Partial-Onset Seizures


    For patients who are already on a single AED and will convert to lacosamide tablets monotherapy, withdrawal of the concomitant AED should not occur until the therapeutic dosage of lacosamide tablet is achieved and has been administered for at least 3 days. A gradual withdrawal of the concomitant AED over at least 6 weeks is recommended. 

    2.3 Dosage Information for Patients with Renal Impairment


    For patients with mild to moderate renal impairment, no dosage adjustment is necessary. 
    For patients with severe renal impairment [creatinine clearance (CL CR) less than 30 mL/min as estimated by the Cockcroft-Gault equation for adults; CLCR less than 30 mL/min/1.73m 2 as estimated by the Schwartz equation for pediatric patients] or end-stage renal disease, a reduction of 25% of the maximum dosage is recommended. 
    In all patients with renal impairment, the dose titration should be performed with caution. 

    Hemodialysis 


    Lacosamide tablet is effectively removed from plasma by hemodialysis. Following a 4-hour hemodialysis treatment, dosage supplementation of up to 50% should be considered.
    Concomitant Strong CYP3A4 or CYP2C9 Inhibitors

    Dose reduction may be necessary in patients with renal impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 [ see Drug Interactions ( 7.1), Use in Specific Populations ( 8.6), and Clinical Pharmacology ( 12.3) ].

    2.4 Dosage Information for Patients with Hepatic Impairment


    For patients with mild or moderate hepatic impairment, a reduction of 25% of the maximum dosage is recommended. The dose titration should be performed with caution in patients with hepatic impairment. Lacosamide tablet use is not recommended in patients with severe hepatic impairment.

    Concomitant Strong CYP3A4 and CYP2C9 Inhibitors 


    Dose reduction may be necessary in patients with hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 [ see Drug Interactions ( 7.1), Use in Specific Populations ( 8.7), and Clinical Pharmacology ( 12.3) ].

    2.5 Administration Instructions for Lacosamide Tablets


    Lacosamide tablets may be taken with or without food.
    Lacosamide tablets
    Lacosamide tablets should be swallowed whole with liquid. Do not divide lacosamide tablets.



    2.7 Discontinuation of Lacosamide Tablets


    When discontinuing lacosamide tablets, a gradual withdrawal over at least 1 week is recommended [ see Warnings and Precautions ( 5.5) ]. 

  • 3 DOSAGE FORMS AND STRENGTHS


    Lacosamide Tablets, USP
    • 50 mg: Pink colored, oval shaped, bi convex, film-coated tablets, debossed with 'J' on one side and '12' on the other side. 
    • 100 mg: Yellow colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '13' on the other side.
    • 150 mg: Salmon colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '14' on the other side.
    • 200 mg: Blue colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '15' on the other side.

  • 4 CONTRAINDICATIONS


    None.

  • 5 WARNINGS AND PRECAUTIONS

    5.1 Suicidal Behavior and Ideation


    Antiepileptic drugs (AEDs), including lacosamide, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression,suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.

    Pooled analyses of 199 placebo-controlledclinical trials (mono- and adjunctive therapy) of 11 different AEDs showed that patients randomized to one of the AEDs had approximately twice the risk (adjusted Relative Risk 1.8, 95% CI:1.2, 2.7) of suicidal thinking orbehaviorcompared to patients randomized to placebo. In these trials, which had a mediantreatment duration of 12 weeks, the estimated incidence of suicidal behavior or ideation among 27,863 AED-treatedpatients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients,representing an increase of approximately one case of suicidal thinking or behavior for every 530 patients treated. There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number of events is too small to allow any conclusion about drug effect onsuicide.

    The increased risk of suicidal thoughts orbehavior withAEDs wasobserved as early as one week after starting treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could notbe assessed.

    The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk didnotvarysubstantiallyby age (5 to 100 years) in the clinical trials analyzed.

    Table 2 shows absolute and relative risk by indication for all evaluated AEDs.

              Table 2:    Risk by Indication for Antiepileptic Drugs in the Pooled Analysis



    Indication
     

    Placebo Patients
    with Events
    Per 1000 Patients

    Drug Patients
    with Events Per
    1000 Patients

    Relative Risk:
    Incidence of
    Events in Drug
    Patients/Incidence
    in Placebo Patients

    Risk Difference:
    Additional Drug
    Patients with
    Events Per 1000
    Patients

    Epilepsy

    1.0

    3.4

    3.5

    2.4

    Psychiatric

    5.7

    8.5

    1.5

    2.9

    Other

    1.0

    1.8

    1.9

    0.9

    Total

    2.4

    4.3

    1.8

    1.9

    The relative risk for suicidal thoughts or behavior was higher in clinical trials for epilepsy than in clinical trials for psychiatric or other conditions, but the absolute risk differences weresimilar. 
    Anyone considering prescribing lacosamide or any other AEDmust balance this risk with the risk of untreated illness. Epilepsy and many other illnessesfor which antiepilepticsareprescribedarethemselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Shouldsuicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of thesesymptomsinanygivenpatientmayberelatedtotheillnessbeingtreated.

    5.2 Dizziness and Ataxia


    Lacosamide may cause dizziness and ataxia in adult and pediatric patients. In adult patients with partial-onset seizures taking 1 to 3 concomitant AEDs, dizziness was experienced by 25% of patients randomized to the recommended doses (200 to 400 mg/day) of lacosamide (compared with 8% of placebo patients) and was the adverse event most frequently leading to discontinuation (3%). Ataxia was experienced by 6% of patients randomized to the recommended doses (200 to 400 mg/day) of lacosamide (compared to 2% of placebo patients). The onset of dizziness and ataxia was most commonly observed during titration. There was a substantial increase in these adverse events at doses higher than 400 mg/day [see Adverse Reactions ( 6.1)].

    5.3 Cardiac Rhythm and Conduction Abnormalities


    PR Interval Prolongation, Atrioventricular Block, and Ventricular Tachyarrhythmia
    Dose-dependent prolongations in PR interval with lacosamide have been observed in clinical studies in adult patients and in healthy volunteers [ see Clinical Pharmacology ( 12.2) ]. In adjunctive clinical trials in adult patients with partial-onset seizures, asymptomatic first-degree atrioventricular (AV) block was observed as an adverse reaction in 0.4% (4/944) of patients randomized to receive lacosamide and 0% (0/364) of patients randomized to receive placebo. One case of profound bradycardia was observed in a patient during a 15-minute infusion of 150 mg lacosamide . When lacosamide is given with other drugs that prolong the PR interval, further PR prolongation is possible. 
    In the postmarketing setting, there have been reports of cardiac arrhythmias in patients treated with lacosamide, including bradycardia, AV block, and ventricular tachyarrhythmia, which have rarely resulted in asystole, cardiac arrest, and death. Most, although not all, cases have occurred in patients with underlying proarrhythmic conditions, or in those taking concomitant medications that affect cardiac conduction or prolong the PR interval. These events have occurred with both oral and intravenous routes of administration and at prescribed doses as well as in the setting of overdose [see Overdosage ( 10)].
    Lacosamide should be used with caution in patients with underlying proarrhythmic conditions such as known cardiac conduction problems (e.g., marked first-degree AV block, second-degree or higher AV block and sick sinus syndrome without pacemaker), severe cardiac disease (such as myocardial ischemia or heart failure, or structural heart disease), and cardiac sodium channelopathies (e.g., Brugada Syndrome). Lacosamide should also be used with caution in patients on concomitant medications that affect cardiac conduction, including sodium channel blockers, beta-blockers, calcium channel blockers, potassium channel blockers, and medications that prolong the PR interval [ see Drug Interactions ( 7.2) ]. In such patients, obtaining an ECG before beginning lacosamide, and after lacosamide is titrated to steady-state maintenance dose, is recommended. In addition, these patients should be closely monitored if they are administered lacosamide through the intravenous route [ see Adverse Reactions ( 6.1) and Drug Interactions ( 7.2)]. 
    Atrial Fibrillation and Atrial Flutter
    In the short-term investigational trials of lacosamide in adult patients with partial-onset seizures there were no cases of atrial fibrillation or flutter. Both atrial fibrillation and atrial flutter have been reported in open label partial-onset seizure trials and in postmarketing experience. In adult  patients with diabetic neuropathy, for which lacosamide is not indicated,  0.5% of patients treated with lacosamide experienced an adverse reaction of atrial fibrillation or atrial flutter, compared to 0% of placebo-treated patients. Lacosamide administration may predispose to atrial arrhythmias (atrial fibrillation or flutter), especially in patients with diabetic neuropathy and/or cardiovascular disease.

    5.4 Syncope


    In the short-term controlled trials of lacosamide in adult patients with partial-onset seizures with no significant system illnesses, there was no increase in syncope compared to placebo. In the short-term controlled trials in adult patients with diabetic neuropathy, for which lacosamide is not indicated, 1.2% of patients who were treated with lacosamide reported an adverse reaction of syncope or loss of consciousness, compared with 0% of placebo-treated patients with diabetic neuropathy. Most of the cases of syncope were observed in patients receiving doses above 400 mg/day. The cause of syncope was not determined in most cases. However, several were associated with either changes in orthostatic blood pressure, atrial flutter/fibrillation (and associated tachycardia), or bradycardia. Cases of syncope have also been observed in open-label clinical partial-onset seizure studies in adult and pediatric patients. These cases were associated with a history of risk factors for cardiac disease and the use of drugs that slow AV conduction.

    5.5 Withdrawal of Antiepileptic Drugs (AEDs)

    As with all AEDs, lacosamide should be withdrawn gradually (over a minimum of 1 week) to minimize the potential of increased seizurefrequency in patients with seizuredisorders.

    5.6 Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multi-Organ Hypersensitivity


    Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), also known as multi-organ hypersensitivity, has been reported in patients taking antiepileptic drugs, including lacosamide. Some of these events have been fatal or life-threatening. DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy and/or facial swelling, in association with other organ system involvement, such as hepatitis, nephritis, hematologic abnormalities, myocarditis, or myositis, sometimes resembling an acute viral infection. Eosinophilia is often present. This disorder is variable in its expression, and other organ systems not noted here may be involved. It is important to note that early manifestations of hypersensitivity (e.g., fever, lymphadenopathy) may be present even though rash is not evident. If such signs or symptoms are present, the patient should be evaluated immediately. Lacosamide should be discontinued if an alternative etiology for the signs or symptoms cannot be established.

  • 6 ADVERSE REACTIONS

    The following serious adverse reactions are described below and elsewhere in the labeling: 

    • Suicidal Behavior and Ideation [see Warnings and Precautions ( 5.1)] 
    • Dizziness and Ataxia [see Warnings and Precautions ( 5.2)] 
    • Cardiac Rhythm and Conduction Abnormalities [see Warnings and Precautions ( 5.3)]  
    • Syncope [see Warnings and Precautions ( 5.4)] 
    • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multiorgan Hypersensitivity Reaction s [see Warnings and Precautions ( 5.6)] 


    6.1 Clinical Trials Experience

    Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

    Lacosamide Tablet in Adults

    In the premarketing development of adjunctive therapy for partial-onset seizures, 1327 adult patients received lacosamide tablets in controlled and uncontrolled trials, of whom 1000 were treated for longer than 6 months, and 852 for longer than 12 months. The monotherapy development program for partial-onset seizures included 425 adult patients, 310 of whom were treated for longer than 6 months, and 254 for longer than 12 months.

    Partial-Onset Seizures

    Monotherapy Historical-Control Trial (Study 1)


    In the monotherapy trial for partial-onset seizures, 16% of patients randomized to receive lacosamide at the recommended doses of 300 and 400 mg/day discontinued from the trial as a result of an adverse reaction. The adverse reaction most commonly (≥1% on lacosamide) leading to discontinuation was dizziness.

    Adverse reactions that occurred in this study were generally similar to those that occurred in adjunctive placebo-controlled studies. One adverse reaction, insomnia, occurred at a rate of ≥2% and was not reported at a similar rate in previous studies. This adverse reaction has also been observed in postmarketing experience [s ee Adverse Reactions ( 6.2) ]. Because this study did not include a placebo control group, causality could not be established.

    Dizziness, headache, nausea, somnolence, and fatigue all occurred at lower incidences during the AED Withdrawal Phase and Monotherapy Phase, compared with the Titration Phase [see Clinical Studies ( 14.1)].

    Adjunctive Therapy Controlled Trials (Studies 2, 3, and 4)


    In adjunctive therapy controlled clinical trials for partial-onset seizures, the rate of discontinuation as a result of an adverse reaction was 8% and 17% in patients randomized to receive lacosamide at the recommended doses of 200 and 400 mg/day, respectively, 29% at 600 mg/day (1.5 times greater than the maximum recommended dose), and 5% in patients randomized to receive placebo. The adverse reactions most commonly (>1% on lacosamide and greater than placebo) leading to discontinuation were dizziness, ataxia, vomiting, diplopia, nausea, vertigo, and blurred vision.

    Table 3 gives the incidence of adverse reactions that occurred in ≥2% of adult patients with partial-onset seizures in the lacosamide total group and for which the incidence was greater than placebo.

    Table 3: Adverse Reactions Incidence in Adjunctive Therapy Pooled, Placebo-Controlled Trials in Adult Patients with Partial-Onset Seizures (Studies 2, 3, and 4)

    Adverse Reaction


    Placebo

    N=364

    %
    Lacosamide

    200 mg/day

    N=270

    %
    Lacosamide

    400 mg/day

    N=471

    %
    Lacosamide

    600 mg/day*

    N=203

    %
    Lacosamide

    Total

    N=944

    %
    Ear and labyrinth disorder
    Vertigo15344
    Eye disorders
    Diplopia26101611
    Blurred Vision329168
    Gastrointestinal disorders
    Nausea47111711
    Vomiting369169
    Diarrhea33544
    General disorders and administration site conditions
    Fatigue677159
    Gait disturbance
    <1
    <1
    2
    4
    2
    Asthenia12242
    Injury, poisoning and procedural complications
    Contusion33423
    Skin laceration22333
    Nervous system disorders
    Dizziness816305331
    Headache911141213
    Ataxia247158
    Somnolence55887
    Tremor446127
    Nystagmus425105
    Balance disorder01564
    Memory impairment2
    1
    2
    6
    2
    Psychiatric disorders
    Depression12222
    Skin and subcutaneous disorders
    Pruritus13232

    *600 mg dose is 1.5 times greater than the maximum recommended dose.


    The overall adverse reaction rate was similar in male and female patients. Although there were few non-Caucasian patients, no differences in the incidences of adverse reactions compared to Caucasian patients were observed.

    Lacosamide Tablets in Pediatric Patients

    Safety of lacosamide was evaluated in clinical studies of pediatric patients 4 to less than 17 years of age for the treatment of partial-onset seizures. Across studies in pediatric patients with partial-onset seizures, 328 patients 4 to less than 17 years of age received lacosamide oral solution or tablet, of whom 148 received lacosamide for at least 1 year. Adverse reactions reported in clinical studies of pediatric patients 4 to less than 17 years of age were similar to those seen in adult patients.

    Laboratory Abnormalities

    Abnormalities in liver function tests have occurred in controlled trials with lacosamide in adult patients with partial-onset seizures who were taking 1 to 3 concomitant anti-epileptic drugs. Elevations of ALT to ≥3x ULN occurred in 0.7% (7/935) of lacosamide patients and 0% (0/356) of placebo patients. One case of hepatitis with transaminases >20x ULN occurred in one healthy subject 10 days after lacosamide treatment completion, along with nephritis (proteinuria and urine casts). Serologic studies were negative for viral hepatitis. Transaminases returned to normal within one month without specific treatment. At the time of this event, bilirubin was normal. The hepatitis/nephritis was interpreted as a delayed hypersensitivity reaction to lacosamide.

    Other Adverse Reactions

    The following is a list of adverse reactions reported by patients treated with lacosamide in all clinical trials in adult patients, including controlled trials and long-term open-label extension trials. Adverse reactions addressed in other tables or sections are not listed here.

    Blood and lymphatic system disorders: neutropenia, anemia

    Cardiac disorders: palpitations

    Ear and labyrinth disorders: tinnitus

    Gastrointestinal disorders: constipation, dyspepsia, dry mouth, oral hypoaesthesia

    General disorders and administration site conditions: irritability, pyrexia, feeling drunk

    Injury, poisoning, and procedural complications: fall

    Musculoskeletal and connective tissue disorders: muscle spasms

    Nervous system disorders: paresthesia, cognitive disorder, hypoaesthesia, dysarthria, disturbance in attention, cerebellar syndrome

    Psychiatric disorders: confusional state, mood altered, depressed mood

    Additional pediatric use information is approved for UCB, Inc.'s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

    6.2 Postmarketing Experience


    The following adverse reactions have been identified during post-approval use of lacosamide. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
    Blood and lymphatic system disorders: Agranulocytosis 
    Psychiatric disorders: Aggression, agitation, hallucination, insomnia, psychotic disorder 
    Skin and subcutaneous tissue disorders: Angioedema, rash, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis.
    Neurologic disorders: Dyskinesia, new or worsening seizures


  • 7 DRUG INTERACTIONS

    7.1 Strong CYP3A4 or CYP2C9 Inhibitors


    Patients with renal or hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 may have a significant increase in exposure to lacosamide. Dose reduction may be necessary in these patients. 


    7.2 Concomitant Medications that Affect Cardiac Conduction


    Lacosamide should be used with caution in patients on concomitant medications that affect cardiac conduction (sodium channel blockers, beta-blockers, calcium channel blockers, potassium channel blockers) including those that prolong PR interval (including sodium channel blocking AEDs), because of a risk of AV block, bradycardia, or ventricular tachyarrhythmia. In such patients, obtaining an ECG before beginning lacosamide, and after lacosamide is titrated to steady-state, is recommended. In addition, these patients should be closely monitored if they are administered lacosamide through the intravenous route [ see Warnings and Precautions ( 5.3) ].

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy


    Pregnancy Exposure Registry

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiepileptic drugs (AEDs), such as lacosamide, during pregnancy. Encourage women who are taking lacosamide during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) pregnancy registry by calling 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org/. 


    Risk Summary 
     There are no adequate data on the developmental risks associated with the use of lacosamide in pregnant women. 
    Lacosamide produced developmental toxicity (increased embryofetal and perinatal mortality, growth deficit) in rats following administration during pregnancy. Developmental neurotoxicity was observed in rats following administration during a period of postnatal development corresponding to the third trimester of human pregnancy. These effects were observed at doses associated with clinically relevant plasma exposures (see Data).
    In the U.S. general population the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. The background risk of major birth defects and miscarriage for the indicated population is unknown.
    Data 
    Animal Data     
    Oral administration of lacosamide to pregnant rats (20, 75, or 200 mg/kg/day) and rabbits (6.25, 12.5, or 25 mg/kg/day) during the period of organogenesis did not produce any effects on the incidences of fetal structural abnormalities. However, the maximum doses evaluated were limited by maternal toxicity in both species and embryofetal death in rats. These doses were associated with maternal plasma lacosamide exposures (AUC) approximately 2 and 1 times (rat and rabbit, respectively) that in humans at the maximum recommended human dose (MRHD) of 400 mg/day. 
    In two studies in which lacosamide (25, 70, or 200 mg/kg/day and 50, 100, or 200 mg/kg/day) was orally administered to rats throughout pregnancy and lactation, increased perinatal mortality and decreased body weights in the offspring were observed at the highest dose tested. The no-effect dose for pre- and postnatal developmental toxicity in rats (70 mg/kg/day) was associated with a maternal plasma lacosamide AUC similar to that in humans at the MRHD. 
    Oral administration of lacosamide (30, 90, or 180 mg/kg/day) to rats during the neonatal and juvenile periods of development resulted in decreased brain weights and long-term neurobehavioral changes (altered open field performance, deficits in learning and memory). The early postnatal period in rats is generally thought to correspond to late pregnancy in humans in terms of brain development. The no-effect dose for developmental neurotoxicity in rats was associated with a plasma lacosamide AUC less than that in humans at the MRHD.
    In Vitro Data
    Lacosamide has been shown in vitro to interfere with the activity of collapsin response mediator protein-2 (CRMP-2), a protein involved in neuronal differentiation and control of axonal outgrowth. Potential adverse effects on CNS development related to this activity cannot be ruled out.

    8.2 Lactation


    Risk Summary 
    There are no data on the presence of lacosamide in human milk, the effects on the breastfed infant, or the effects on milk production. Studies in lactating rats have shown excretion of lacosamide and/or its metabolites in milk. 
    The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for lacosamide and any potential adverse effects on the breastfed infant from lacosamide or from the underlying maternal condition.

    8.4 Pediatric Use


    Partial-Onset Seizures
    Safety and effectiveness of lacosamide tablets for the treatment of partial-onset seizures have been established in pediatric patients 4 years to less than 17 years of age. Use of lacosamide in this age group is supported by evidence from adequate and well-controlled studies of lacosamide in adults with partial-onset seizures, pharmacokinetic data from adult and pediatric patients, and safety data in  328 pediatric patients 4 years to less than 17 years of age [see Adverse Reactions ( 6.1), Clinical Pharmacology ( 12.3), and Clinical Studies ( 14.1, 14.2)]
    Safety and effectiveness in pediatric patients below 1 month of age have not been established.
    Animal Data
    Lacosamide has been shown in vitro to interfere with the activity of collapsin response mediator protein-2 (CRMP-2), a protein involved in neuronal differentiation and control of axonal outgrowth. Potential related adverse effects on CNS development cannot be ruled out. Administration of lacosamide to rats during the neonatal and juvenile periods of postnatal development (approximately equivalent to neonatal through adolescent development in humans) resulted in decreased brain weights and long-term neurobehavioral changes (altered open field performance, deficits in learning and memory). The no-effect dose for developmental neurotoxicity in rats was associated with a plasma lacosamide exposure (AUC) less than that in humans at the maximum recommended human dose of 400 mg/day.
    Additional pediatric use information is approved for UCB, Inc.'s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

    8.5 Geriatric Use


    There were insufficient numbers of elderly patients enrolled in partial-onset seizure trials (n=18) to adequately determine whether they respond differently from younger patients.
    No lacosamide dose adjustment based on age is necessary. In elderly patients, dose titration should be performed with caution, usually starting at the lower end of the dosing range, reflecting the greater frequency of decreased hepatic function, decreased renal function, increased cardiac conduction abnormalities, and polypharmacy [ see Dosage and Administration ( 2.1, 2.3, 2.4) and Clinical Pharmacology ( 12.3) ].


    8.6 Renal Impairment


    Based on data in adults, no dose adjustment is necessary in adult and pediatric patients with mild to moderate renal impairment (CL CR ≥30 mL/min). In adult and pediatric patients with severe renal impairment (CL CR <30 mL/min) and in those with end-stage renal disease, a reduction of 25% of the maximum dosage is recommended [see Dosage and Administration ( 2.3) and Clinical Pharmacology ( 12.3)].
    In all patients with renal impairment, dose titration should be performed with caution.
    Lacosamide is effectively removed from plasma by hemodialysis. Dosage supplementation of up to 50% following hemodialysis should be considered.

    8.7 Hepatic Impairment


    Based on data in adults, for adult and pediatric patients with mild to moderate hepatic impairment, a reduction of 25% of the maximum dosage is recommended. Patients with mild to moderate hepatic impairment should be observed closely during dose titration [ see Dosage and Administration ( 2.4), Clinical Pharmacology ( 12.3) ].
    The pharmacokinetics of lacosamide has not been evaluated in severe hepatic impairment. Lacosamide use is not recommended in patients with severe hepatic impairment.


  • 9 DRUG ABUSE AND DEPENDENCE

    9.1 Controlled Substance

    Lacosamide is a Schedule V controlled substance.

    9.2 Abuse


    In a human abuse potential study, single doses of 200 mg and 800 mg lacosamideproducedeuphoria-type subjective responses thatdifferentiated statistically from placebo; at 800mg, these euphoria-type responses werestatistically indistinguishable from those produced by alprazolam, a Schedule IV drug. The duration of the euphoria-type responses following lacosamidewas less than that following alprazolam. A high rate of euphoriawas also reported as an adverse event in the human abuse potential study following single doses of 800 mg lacosamide (15% [5/34]) compared to placebo (0%) and in two pharmacokineticstudiesfollowing single and multipledosesof300 to 800mglacosamide(rangingfrom6%[2/33] to 25%[3/12])compared to placebo (0%). However, the rate of euphoriareported as an adverse event in the lacosamidedevelopment program at therapeutic doses was less than 1%.

    9.3 Dependence

    Abrupt termination of lacosamide in clinicaltrials with diabetic neuropathic pain patients produced no signs or symptoms that are associatedwith a withdrawalsyndrome indicative of physical dependence. However, psychological dependence cannot be excluded due to the ability of lacosamide to produce euphoria-type adverse events in humans.

  • 10 OVERDOSAGE


    Events reported after an intake of more than 800 mg (twice the maximum recommended daily dosage) of lacosamide include dizziness, nausea, and seizures (generalized tonic-clonic seizures, status epilepticus). Cardiac conduction disorders, confusion, decreased level of consciousness, cardiogenic shock, cardiac arrest, and coma have also been observed. Fatalities have occurred following lacosamide overdoses of several grams.
    There is no specific antidote for overdose with lacosamide. Standard decontamination procedures should be followed. General supportive care of the patient is indicated including monitoring of vital signs and observation of the clinical status of patient. A Certified Poison Control Center should be contacted for up to date information on the management of overdose with lacosamide.

    Standard hemodialysis procedures result in significant clearance of lacosamide (reduction of systemic exposure by 50% in 4 hours). Hemodialysis may be indicated based on the patient's clinical state or in patients with significant renal impairment.

  • 11 DESCRIPTION


    The chemicalname of lacosamide, the single (R)- enantiomer, is (R)- N- Benzyl-2- acetamido-3- methoxypropionamide.Lacosamide is a functionalized amino acid. Its molecularformula is C13H18N2O3 and its molecular weight is 250.29. The chemical structure is:


    Chemical Structure

    Lacosamide, USP is a white to light yellow powder. It is freely soluble in methanol, soluble in anhydrous ethanol, sparingly soluble in water, slightly soluble in acetonitrile practically insoluble in heptane.


    11.1 Lacosamide Tablets, USP


    Lacosamide tablets, USP for oral administration contain lacosamide and the following inactive ingredients: colloidal silicon dioxide, crospovidone, hydroxypropyl cellulose, hypromellose, lecithin, low substituted hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, talc and titanium dioxide. In addition to this the 50 mg tablets contain FD&C Blue #2/indigo carmine aluminum lake, iron oxide black and iron oxide red. 100 mg tablets contain iron oxide yellow. 150 mg tablets contain iron oxide black, iron oxide red and iron oxide yellow. 200 mg tablets contain FD&C Blue #2/indigo carmine aluminum lake.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    The precisemechanism by which lacosamide exerts its antiepileptic effects in humansremains to be fully elucidated. In vitroelectrophysiological studies have shown that lacosamideselectively enhances slow inactivation of voltage-gated sodium channels, resulting in stabilizationof hyperexcitable neuronalmembranes and inhibition of repetitive neuronal firing.

    12.2 Pharmacodynamics



    A pharmacokinetic-pharmacodynamic (efficacy) analysis was performed based on the pooled data from the 3 efficacy trials for partial-onset seizures.Lacosamide exposure is correlated with the reduction in seizure frequency. However, doses above 400 mg/day do not appear to confer additional benefit in group analyses.
    Cardiac Electrophysiology
    Electrocardiographic effects of lacosamide were determined in a double-blind, randomized clinical pharmacology trial of 247 healthy subjects. Chronic oral doses of 400 and 800 mg/day were compared with placebo and a positive control (400 mg moxifloxacin). Lacosamide did not prolong QTc interval and did not have a dose-related or clinically important effect on QRS duration. Lacosamide produced a small, dose-related increase in mean PR interval. At steady-state, the time of the maximum observed mean PR interval corresponded with t max. The placebo-subtracted maximum increase in PR interval (at t max) was 7.3 ms for the 400 mg/day group and 11.9 ms for the 800 mg/day group. For patients who participated in the controlled trials, the placebo-subtracted mean maximum increase in PR interval for a 400 mg/day lacosamide dose was 3.1 ms in patients with partial-onset seizures and 9.4 ms for patients with diabetic neuropathy.


    12.3 Pharmacokinetics


    The pharmacokinetics of lacosamide have been studied in healthy adult subjects (age range 18 to 87), adults with partial-onset seizures, adults with diabetic neuropathy, and subjects with renal and hepatic impairment.
    The pharmacokinetics of lacosamide are similar in healthy subjects, patients with partial-onset seizures, and patients with primary generalized tonic-clonic seizures.
    Lacosamide is completely absorbed after oral administration with negligible first-pass effect with a high absolute bioavailability of approximately 100%. The maximum lacosamide plasma concentrations occur approximately 1 to 4 hour post-dose after oral dosing, and elimination half-life is approximately 13 hours. Steady state plasma concentrations are achieved after 3 days of twice daily repeated administration. Pharmacokinetics of lacosamide are dose proportional (100 to 800 mg) and time invariant, with low inter- and intra-subject variability. Compared to lacosamide the major metabolite, O-desmethyl metabolite, has a longer T max (0.5 to 12 hours) and elimination half-life (15 to 23 hours).
    Absorption and Bioavailability

    Lacosamide is completely absorbed after oral administration. The oral bioavailability of lacosamide tablets is approximately 100%. Food does not affect the rate and extent of absorption.
    After intravenous administration, C max is reached at the end of infusion. The 30- and 60- minute intravenous infusions are bioequivalent to the oral tablet. For the 15-minute intravenous infusion, bioequivalence was met for AUC (0 to tz) but not for C max. The point estimate of C max was 20% higher than C max for oral tablet and the 90% CI for C max exceeded the upper boundary of the bioequivalence range.
    In a trial comparing the oral tablet with an oral solution containing 10 mg/mL lacosamide, bioequivalence between both formulations was shown.
    A single loading dose of 200 mg approximates steady-state concentrations comparable to the 100 mg twice daily oral administration.
    Distribution
    The volume of distribution is approximately 0.6 L/kg and thus close to the volume of total body water. Lacosamide is less than 15% bound to plasma proteins.
    Metabolism and Elimination
    Lacosamide is primarily eliminated from the systemic circulation by renal excretion and biotransformation.
    After oral administration of 100 mg [14C]-lacosamide approximately 95% of radioactivity administered was recovered in the urine and less than 0.5% in the feces. The major compounds excreted were unchanged lacosamide (approximately 40% of the dose), its O-desmethyl metabolite (approximately 30%), and a structurally unknown polar fraction (~20%). The plasma exposure of the major human metabolite, O-desmethyl-lacosamide, is approximately 10% of that of lacosamide. This metabolite has no known pharmacological activity.
    The CYP isoforms mainly responsible for the formation of the major metabolite (O-desmethyl) are CYP3A4, CYP2C9, and CYP2C19. The elimination half-life of the unchanged drug is approximately 13 hours and is not altered by different doses, multiple dosing or intravenous administration.
    There is no enantiomeric interconversion of lacosamide.
    Specific Populations
    Renal Impairment
    Lacosamide and its major metabolite are eliminated from the systemic circulation primarily by renal excretion.
    The AUC of lacosamide was increased approximately 25% in mildly (CL CR 50 to 80 mL/min) and moderately (CL CR 30 to 50 mL/min) and 60% in severely (CL CR ≤30 mL/min) renally impaired patients compared to subjects with normal renal function (CL CR >80 mL/min), whereas C max was unaffected. Lacosamide is effectively removed from plasma by hemodialysis. Following a 4-hour hemodialysis treatment, AUC of lacosamide is reduced by approximately 50% [ see Dosage and Administration ( 2.3) ].
    Hepatic Impairment
    Lacosamide undergoes metabolism. Subjects with moderate hepatic impairment (Child-Pugh B) showed higher plasma concentrations of lacosamide (approximately 50 to 60% higher AUC compared to healthy subjects). The pharmacokinetics of lacosamide have not been evaluated in severe hepatic impairment [ see Dosage and Administration ( 2.4) ].

    Pediatric Patients (4 to less than 17 Years of Age)
    The pediatric pharmacokinetic profile of lacosamide was determined in a population pharmacokinetic analysis using sparse plasma concentration data obtained in two open-label studies in 79 pediatric patients with epilepsy aged 4 years to less than 17 years who received oral solution or oral tablet formulations.
    A weight based dosing regimen is necessary to achieve lacosamide exposures in pediatric patients 4 years to less than 17 years of age similar to those observed in adults treated at effective doses of lacosamide [see Dosage and Administration ( 2.1)] . For patients weighing 11 kg, 28.9 kg (the mean population body weight), and 70 kg, the typical plasma half-life (t 1/2) is 7.4 hours, 10.6 hours, and 14.8 hours, respectively. Steady state plasma concentrations are achieved after 3 days of twice daily repeated  administration.
    The pharmacokinetics of lacosamide in pediatric patients are similar when used as monotherapy or as adjunctive therapy for the treatment of partial-onset seizures.
    Additional pediatric use information is approved for UCB, Inc.'s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

    Geriatric Patients
    In the elderly (>65 years), dose and body-weight normalized AUC and C max is about 20% increased compared to young subjects (18 to 64 years). This may be related to body weight and decreased renal function in elderly subjects.


    Gender
    Lacosamide clinical trials indicate that gender does not have a clinically relevant influence on the pharmacokinetics of lacosamide.
    Race
    There are no clinically relevant differences in the pharmacokinetics of lacosamide between Asian, Black, and Caucasian subjects.
    CYP2C19 Polymorphism
    There are no clinically relevant differences in the pharmacokinetics of lacosamide between CYP2C19 poor metabolizers and extensive metabolizers. Results from a trial in poor metabolizers (PM) (N=4) and extensive metabolizers (EM) (N=8) of cytochrome P450 (CYP) 2C19 showed that lacosamide plasma concentrations were similar in PMs and EMs, but plasma concentrations and the amount excreted into urine of the O-desmethyl metabolite were about 70% reduced in PMs compared to EMs.
    Drug Interactions
    In Vitro Assessment of Drug Interactions
    In vitro metabolism studies indicate that lacosamide does not induce the enzyme activity of drug metabolizing cytochrome P450 isoforms CYP1A2, 2B6, 2C9, 2C19 and 3A4. Lacosamide did not inhibit CYP 1A1, 1A2, 2A6, 2B6, 2C8, 2C9, 2D6, 2E1, 3A4/5 at plasma concentrations observed in clinical studies.
    In vitro data suggest that lacosamide has the potential to inhibit CYP2C19 at therapeutic concentrations. However, an in vivo study with omeprazole did not show an inhibitory effect on omeprazole pharmacokinetics.
    Lacosamide was not a substrate or inhibitor for P-glycoprotein.
    Lacosamide is a substrate of CYP3A4, CYP2C9, and CYP2C19. Patients with renal or hepatic impairment who are taking strong inhibitors of CYP3A4 and CYP2C9 may have increased exposure to lacosamide.
    Since <15% of lacosamide is bound to plasma proteins, a clinically relevant interaction with other drugs through competition for protein binding sites is unlikely.
    In Vivo Assessment of Drug Interactions
    • Drug interaction studies with AEDs

    Effect of lacosamide on concomitant AEDs
    Lacosamide 400 mg/day had no influence on the pharmacokinetics of 600 mg/day valproic acid and 400 mg/day carbamazepine in healthy subjects.
    The placebo-controlled clinical studies in patients with partial-onset seizures showed that steady-state plasma concentrations of levetiracetam, carbamazepine, carbamazepine epoxide, lamotrigine, topiramate, oxcarbazepine monohydroxy derivative (MHD), phenytoin, valproic acid, phenobarbital, gabapentin, clonazepam, and zonisamide were not affected by concomitant intake of lacosamide at any dose.
    Effect of concomitant AEDs on lacosamide
    Drug-drug interaction studies in healthy subjects showed that 600 mg/day valproic acid had no influence on the pharmacokinetics of 400 mg/day lacosamide. Likewise, 400 mg/day carbamazepine had no influence on the pharmacokinetics of lacosamide in a healthy subject study. Population pharmacokinetics results in patients with partial-onset seizures showed small reductions (15% to 20% lower) in lacosamide plasma concentrations when lacosamide were coadministered with carbamazepine, phenobarbital or phenytoin.
    • Drug-drug interaction studies with other drugs
    Digoxin
    There was no effect of lacosamide (400 mg/day) on the pharmacokinetics of digoxin (0.5 mg once daily) in a study in healthy subjects.
    Metformin
    There were no clinically relevant changes in metformin levels following coadministration of lacosamide (400 mg/day).
    Metformin (500 mg three times a day) had no effect on the pharmacokinetics of lacosamide (400 mg/day).
    Omeprazole
    Omeprazole is a CYP2C19 substrate and inhibitor.
    There was no effect of lacosamide (600 mg/day) on the pharmacokinetics of omeprazole  (40 mg single dose) in healthy subjects. The data indicated that lacosamide had little in vivo inhibitory or inducing effect on CYP2C19.
    Omeprazole at a dose of 40 mg once daily had no effect on the pharmacokinetics of lacosamide (300 mg single dose). However, plasma levels of the O-desmethyl metabolite were reduced about 60% in the presence of omeprazole.
    o  Midazolam
    Midazolam is a 3A4 substrate.
    There was no effect of lacosamide (200 mg single dose or repeat doses of 400 mg/day given as 200 mg BID) on the pharmacokinetics of midazolam (single dose, 7.5 mg), indicating no inhibitory or inducing effects on CYP3A4.
    Oral Contraceptives
    There was no influence of lacosamide (400 mg/day) on the pharmacodynamics and pharmacokinetics of an oral contraceptive containing 0.03 mg ethinylestradiol and 0.15 mg levonorgestrel in healthy subjects, except that a 20% increase in ethinylestradiol C max was observed.
    Warfarin
    Co-administration of lacosamide (400 mg/day) with warfarin (25 mg single dose) did not result in a clinically relevant change in the pharmacokinetic and pharmacodynamic effects of warfarin in a study in healthy male subjects.

  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility


    Carcinogenesis
    There was no evidence of drug related carcinogenicity in mice or rats. Mice and rats received lacosamide once daily by oral administration for 104 weeks at doses producing plasma exposures (AUC) up to approximately 1 and 3 times, respectively, the plasma AUC in humans at the maximum recommended human dose (MRHD) of 400 mg/day.
    Mutagenesis
    Lacosamide was negative in an in vitro Ames test and an in vivo mouse micronucleus assay. Lacosamide induced a positive response in the in vitro mouse lymphoma assay.
    Fertility
    No adverse effects on male or female fertility or reproduction were observed in rats at doses producing plasma exposures (AUC) up to approximately 2 times the plasma AUC in humans at the MRHD.

  • 14 CLINICAL STUDIES

    14.1 Monotherapy in Patients with Partial-Onset Seizures


    The efficacy of lacosamide in monotherapy was established in a historical-control, multicenter, randomized trial that included 425 patients, age 16 to 70 years, with partial-onset seizures (Study 1). To be included in Study 1, patients were required to be taking stable doses of 1 or 2 marketed antiepileptic drugs. This treatment continued into the 8 week baseline period. To remain in the study, patients were required to have at least 2 partial-onset seizures per 28 days during the 8 week baseline period. The baseline period was followed by a 3 week titration period, during which lacosamide was added to the ongoing antiepileptic regimen. This was followed by a 16-week maintenance period (i.e., a 6-week withdrawal period for background antiepileptic drugs, followed by a 10-week monotherapy period). Patients were randomized 3 to 1 to receive lacosamide 400 mg/day or lacosamide 300 mg/day. Treatment assignments were blinded. Response to treatment was based upon a comparison of the number of patients who met exit criteria during the maintenance phase, compared to historical controls. The historical control consisted of a pooled analysis of the control groups from 8 studies of similar design, which utilized a sub-therapeutic dose of an antiepileptic drug. Statistical superiority to the historical control was considered to be demonstrated if the upper limit from a 2-sided 95% confidence interval for the percentage of patients meeting exit criteria in patients receiving lacosamide  remained below the lower 95% prediction limit of 65% derived from the historical control data.
    The exit criteria were one or more of the following: (1) doubling of average monthly seizure frequency during any 28 consecutive days, (2) doubling of highest consecutive 2-day seizure frequency, (3) occurrence of a single generalized tonic-clonic seizure, (4) clinically significant prolongation or worsening of overall seizure duration, frequency, type or pattern considered by the investigator to require trial discontinuation, (5) status epilepticus or new onset of serial/cluster seizures. The study population profile appeared comparable to that of the historical control population.
    For the lacosamide 400 mg/day group, the estimate of the percentage of patients meeting at least 1 exit criterion was 30% (95% CI: 25%, 36%). The upper limit of the 2-sided 95% CI (36%) was below the threshold of 65% derived from the historical control data, meeting the pre-specified criteria for efficacy. Lacosamide 300 mg/day also met the pre-specified criteria for efficacy.

    14.2 Adjunctive Therapy in Patients with Partial-Onset Seizures


    The efficacy of lacosamide as adjunctive therapy in partial-onset seizures was established in three 12-week, randomized, double-blind,placebo-controlled, multicenter trials in adult patients (Study 2, Study 3, and Study 4). Enrolled patientshadpartial-onsetseizureswithorwithoutsecondarygeneralization, and werenot adequately controlled with 1 to 3 concomitantAEDs.During an 8-week baseline period, patients were required to have an average of ≥4 partial-onset seizures per 28 days with no seizure-freeperiod exceeding 21 days. In these 3 trials, patients had a mean duration of epilepsy of 24 years and a median baseline seizure frequency ranging from 10 to 17 per28days.84%ofpatientswere taking 2 to 3 concomitant AEDs with or without concurrent vagal nerve stimulation.

    Study 2 compared doses of lacosamide 200, 400, and 600mg/daywithplacebo.Study 3 compared doses of lacosamide 400 and 600 mg/day with placebo. Study 4 compared doses of lacosamide 200 and 400mg/day with placebo. In all three trials, following an 8-week baseline phase to establish baseline seizure frequency prior to randomization, patients were randomized and titrated to the randomizeddose (a 1-step back-titrationof lacosamide 100 mg/day or placebo was allowed in the case of intolerable adverse events at the end of the titrationphase). During the titration phase, in all 3 adjunctive therapy trials,treatment was initiated at 100 mg/day (50 mg twice daily), and increased in weekly increments of 100 mg/day to the target dose. The titration phase lasted 6 weeks in Study 2 and Study 3, and 4 weeks in Study 4. In all three trials, the titration phase was followed by a maintenance phase that lasted 12 weeks, during which patients were to remain on a stable dose of lacosamide.
    A reduction in 28 day seizure frequency (baseline to maintenance phase), as compared to the placebo group, was the primaryvariable in all three adjunctivetherapytrials. A statistically significant effect was observed with lacosamidetreatment (Figure 1) at doses of 200 mg/day (Study 4), 400 mg/day (Studies 2, 3, and 4), and 600 mg/day (Studies 2 and 3).
    Subset evaluations of lacosamidedemonstrate no important differences in seizure control as a function of gender or race, although data on race was limited(about 10% of patients were non- Caucasian).
    Figure 1 -  Median Percent Reduction in Seizure Frequency per 28 days from Baseline to the Maintenance Phase by Dose


    lacosamide-fig1

       Figure 2 presents the percentage of patients (X-axis) with a percent reduction in partialseizure frequency (responder rate) from baseline to the maintenance phase at least as great as that represented on the Y-axis. A positive value on the Y-axis indicates an improvement from baseline (i.e., a decrease in seizure frequency), while a negative value indicates a worsening from baseline (i.e., an increase in seizure frequency). Thus, in a display of this type, a curve for an effectivetreatment is shifted to the left of the curve for placebo. The proportion of patients achieving any particularlevel of reduction in seizure frequency was consistently higher for the lacosamide groups, compared to the placebo group. For example, 40% of patients randomized to lacosamide (400 mg/day) experienced a 50% or greater reduction in seizure frequency, compared to 23% of patientsrandomized to placebo.Patients with an increase in seizure frequency >100% are represented on the Y-axis as equal to or greater than -100%.

    Figure 2 – Proportion of Patients by Responder Rate for Lacosamide and Placebo Groups in Studies 2, 3 and 4


    lacosamide-fig2

    Additional pediatric use information is approved for UCB, Inc.'s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.'s marketing exclusivity rights, this drug product is not labeled with that pediatric information.

  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    16.1 How Supplied


    Lacosamide Tablets USP, 50 mg are pink colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '12' on the other side. They are supplied as follows:
    Bottle of 60 Tablets                                                                    NDC 31722-812-60
    Bottle of 180 Tablets                                                                  NDC 31722-812-18
    Bottle of 500 Tablets                                                                  NDC 31722-812-05
    Blister pack of 100 (10 x 10s) Unit dose tablets (Alu-Alu)          NDC 31722-812-32
    Lacosamide Tablets USP, 100 mg are yellow colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '13' on the other side.

    Bottle of 60 Tablets                                                                     NDC 31722-813-60
    Bottle of 180 Tablets                                                                   NDC 31722-813-18
    Bottle of 500 Tablets                                                                   NDC 31722-813-05
    Blister pack of 100 (10 x 10s) Unit dose tablets (Alu-Alu)          NDC 31722-813-32


    Lacosamide Tablets USP, 150 mg are salmon colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '14' on the other side.
    Bottle of 60 Tablets                                                                     NDC 31722-814-60
    Bottle of 180 Tablets                                                                   NDC 31722-814-18
    Bottle of 500 Tablets                                                                   NDC 31722-814-05
    Blister pack of 100 (10 x 10s) Unit dose tablets (Alu-Alu)          NDC 31722-814-32
    Lacosamide Tablets USP, 200 mg are blue colored, oval shaped, biconvex, film-coated tablets, debossed with 'J' on one side and '15' on the other side.
    Bottle of 60 Tablets                                                                      NDC 31722-815-60
    Bottle of 180 Tablets                                                                    NDC 31722-815-18
    Bottle of 500 Tablets                                                                    NDC 31722-815-05 
    Blister pack of 100 (10 x 10s) Unit dose tablets (Alu-Alu)           NDC 31722-815-32

    16.2 Storage and Handling


    Store at 20º to 25ºC (68º to 77ºF) [see USP Controlled Room Temperature].

  • 17 PATIENT COUNSELING INFORMATION



    Advise the patient or caregiver to read the FDA-approved patient labeling (Medication Guide). The Medication Guide accompanies the product and can also be accessed by calling 1-866-495-1995.
    Suicidal Thinking and Behavior
    Patients, their caregivers, and families should be counseled that AEDs, including lacosamide tablets, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers [ see Warnings and Precautions ( 5.1) ].
    Dizziness and Ataxia
    Patients should be counseled that lacosamide tablets use may cause dizziness, double vision, abnormal coordination and balance, and somnolence. Patients taking lacosamide tablets should be advised not to drive, operate complex machinery, or engage in other hazardous activities until they have become accustomed to any such effects associated with lacosamide tablets [ see Warnings and Precautions ( 5.2) ].
    Cardiac Rhythm and Conduction Abnormalities
    Patients should be counseled that lacosamide tablets are associated with electrocardiographic changes that may predispose to irregular heart beat and syncope. Cardiac arrest has been reported. This risk is increased in patients with underlying cardiovascular disease, with heart conduction problems, or who are taking other medications that affect the heart. Patients should be made aware of and report cardiac signs or symptoms to their healthcare provider right away.  Patients who develop syncope should lay down with raised legs and contact their health care provider [ see Warnings and Precautions ( 5.3) ].
    Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multi-Organ Hypersensitivity
    Patients should be aware that lacosamide tablets may cause serious hypersensitivity reactions affecting multiple organs such as the liver and kidney. Lacosamide tablets should be discontinued if a serious hypersensitivity reaction is suspected. Patients should also be instructed to report promptly to their physicians any symptoms of liver toxicity (e.g., fatigue, jaundice, dark urine) [ see Warnings and Precautions ( 5.6) ].
    Pregnancy Registry
    Advise patients to notify their healthcare provider if they become pregnant or intend to become pregnant during lacosamide tablets therapy. Encourage patients to enroll in the North American Antiepileptic Drug (NAAED) pregnancy registry if they become pregnant. This registry is collecting information about the safety of AEDs during pregnancy [ see Use in Specific Populations ( 8.1) ].

    lacosamide-logo1

    Manufactured for:


    Camber Pharmaceuticals, Inc.
    Piscataway, NJ 08854
    By: Annora Pharma Pvt. Ltd.
    Sangareddy - 502313, Telangana, India.
    Revised: 03/2022

  • MEDICATION GUIDE




    Lacosamide film-coated tablets, USP for oral use, CV
    (lah-KOE-sa-mide)

     Read this Medication Guide before you start taking lacosamide tablets and each time you get a refill. There may be new information. This Medication Guide describes important safety information about lacosamide tablets. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.


    What is the most important information I should know about lacosamide tablets?
    Do not stop taking lacosamide tablets without first talking to your healthcare provider.
    Stopping lacosamide tablets suddenly can cause serious problems. Stopping seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).

    Lacosamide tablets can cause serious side effects, including:
    1.  Like other antiepileptic drugs, lacosamide tablets may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.
    Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you:
    • thoughts about suicide or dying                                           • trouble sleeping (insomnia)
    • attempt to commit suicide                                                    • new or worse irritability
    • new or worse depression                                                     • acting aggressive, being angry, or violent
    • new or worse anxiety                                                           • acting on dangerous impulses
    • feeling agitated or restless                                                   • an extreme increase in activity and talking (mania)
    • panic attacks                                                                        • other unusual changes in behavior or mood How can I watch for early symptoms of suicidal thoughts and actions?
    • Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings.
    • Keep all follow-up visits with your healthcare provider as scheduled.
    • Call your healthcare provider between visits as needed, especially if you are worried about symptoms.
    • Suicidal thoughts or actions can be caused by things other than medicines. If you have suicidal thoughts or actions, your healthcare provider may check for other causes.

    2. Lacosamide tablets may cause you to feel dizzy, have double vision, feel sleepy, or have problems with coordination and walking. Do not drive, operate heavy machinery, or do other dangerous activities until you know how lacosamide tablet affects you.
    3. Lacosamide tablets may cause you to have an irregular heartbeat or may cause you to faint. In rare cases, cardiac arrest has been reported. Call your healthcare provider right away if you:  
    • have a fast, slow, or pounding heartbeat  or feel your heart skip a beat • feel lightheaded
    • have shortness of breath
    • have chest pain • fainted or if you feel like you are going to faint
    If you have fainted or feel like you are going to faint you should lay down with your legs raised.
    4.  Lacosamide is a federally controlled substance (CV) because it can be abused or lead to drug dependence. Keep your lacosamide tablets in a safe place, to protect it from theft. Never give your lacosamide tablets to anyone else, because it may harm them. Selling or giving away this medicine is against the law.

    What is lacosamide tablets?
    Lacosamide tablets are a prescription medicine used:
    • to treat partial-onset seizures in people 4 years of age and older.
    It is not known if lacosamide tablets are safe and effective for partial-onset seizures in children under 1 month of age.

    What should I tell my healthcare provider before taking lacosamide tablets?
    Before you take lacosamide tablets, tell your healthcare provider about all of your medical conditions, including if you:
    • have or have had depression, mood problems or suicidal thoughts or behavior.
    • have heart problems.
    • have kidney problems.
    • have liver problems.
    • have abused prescription medicines, street drugs or alcohol in the past.
    • are pregnant or plan to become pregnant. It is not known if lacosamide tablets can harm your unborn baby. Tell your healthcare provider right away if you become pregnant while taking lacosamide tablets. You and your healthcare provider will decide if you should take lacosamide tablets while you are pregnant.
    o If you become pregnant while taking lacosamide tablets, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. You can enroll in this registry by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic medicine during pregnancy.
    • are breastfeeding or plan to breastfeed. It is not known if lacosamide passes into your breast milk or if it can harm your baby. Talk to your healthcare provider about the best way to feed your baby if you take lacosamide tablets.
    Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
    Taking lacosamide tablets with certain other medicines may cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider. Know the medicines you take. Keep a list of them and show it to your healthcare provider and pharmacist each time you get a new medicine.
      How should I take lacosamide tablets?
    •  Take lacosamide exactly as your healthcare provider tells you.
    •  Your healthcare provider will tell you how much lacosamide to take and when to take it.
    •  Your healthcare provider may change your dose if needed.
    •   Do not stop lacosamide tablets without first talking to a healthcare provider. Stopping lacosamide tablets suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).
    •  Lacosamide tablets may be taken with or without food.
    •  Swallow lacosamide tablets whole with liquid. Do not cut lacosamide tablets.
    •  If you take too much lacosamide, call your healthcare provider or local Poison Control Center right away.
    What should I avoid while taking lacosamide tablets?
    Do not drive, operate heavy machinery, or do other dangerous activities until you know how lacosamide tablet affects you. Lacosamide tablets may cause you to feel dizzy, have double vision, feel sleepy, or have problems with coordination and walking.
    What are the possible side effects of lacosamide tablets?
    • 
    See “What is the most important information I should know about lacosamide tablets?”.
    Lacosamide tablets may cause other serious side effects including:

    • A serious allergic reaction that may affect your skin or other parts of your body such as your liver or blood cells. Call your healthcare provider right away if you have:            o a skin rash, hives                                                o swelling of the legs
    o fever or swollen glands that do not go away      o yellowing of the skin or whites of the eyes
    o shortness of breath                                             o dark urine
    o tiredness (fatigue)  

    The most common side effects of lacosamide tablets include:
    • double vision              • nausea
    • headache                   • sleepiness
    • dizziness      
    These are not all of the possible side effects of lacosamide tablets. For more information ask your healthcare provider or pharmacist. Tell your healthcare provider about any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
      How should I store lacosamide tablets?
    • Store lacosamide tablets at room temperature between 68º to 77ºF (20º to 25ºC).  
    Keep lacosamide tablets and all medicines out of the reach of children.
    General Information about the safe and effective use of lacosamide tablets.
    Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use lacosamide tablets for a condition for which it was not prescribed. Do not give lacosamide tablets to other people, even if they have the same symptoms that you have. It may harm them.
    This Medication Guide summarizes the most important information about lacosamide tablets. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information about lacosamide tablets that is written for health professionals.

    What are the ingredients in lacosamide tablets?
    Active ingredient: lacosamide
    Tablet inactive ingredients: colloidal silicon dioxide, crospovidone, hydroxypropyl cellulose, hypromellose, lecithin, low substituted hydroxypropyl cellulose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, talc and titanium dioxide. In addition to this the 50 mg tablets contain FD&C Blue #2/indigo carmine aluminum lake, iron oxide black and iron oxide red.100 mg tablets contain iron oxide yellow. 150 mg tablets contain iron oxide black, iron oxide red and iron oxide yellow. 200 mg tablets contain FD&C Blue #2/indigo carmine aluminum lake.

    Additional pediatric use information is approved for UCB, Inc.’s VIMPAT ® (lacosamide) tablets. However, due to UCB, Inc.’s marketing exclusivity rights, this drug product is not labeled with that pediatric information

    For more information, call 1-866-495-1995.Medication Guide available at http://camberpharma.com/medication-guides

    This Medication Guide has been approved by the U.S. Food and Drug Administration lacosamide-logo2Manufactured for:
    Camber Pharmaceuticals, Inc.
    Piscataway, NJ 08854
    By: Annora Pharma Pvt. Ltd.
    Sangareddy - 502313, Telangana, India.
    Revised: 03/2022
  • PACKAGE LABEL.PRINCIPAL DISPLAY PANEL


    Lacosamide Tablets, 50 mg - 60's Count


    lacosamide-fig4

      
    Lacosamide Tablets, 100 mg - 60's Count


    lacosamide-fig5


    Lacosamide Tablets, 150 mg - 60's Count


    lacosamide-fig6


    Lacosamide Tablets,  200  mg  - 60's Count


    lacosamide-fig7
  • INGREDIENTS AND APPEARANCE
    LACOSAMIDE 
    lacosamide tablet, film coated
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:31722-812
    Route of AdministrationORALDEA ScheduleCV    
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    LACOSAMIDE (UNII: 563KS2PQY5) (LACOSAMIDE - UNII:563KS2PQY5) LACOSAMIDE50 mg
    Inactive Ingredients
    Ingredient NameStrength
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    CROSPOVIDONE (UNII: 68401960MK)  
    HYDROXYPROPYL CELLULOSE (UNII: RFW2ET671P)  
    HYPROMELLOSE 2910 (5 MPA.S) (UNII: R75537T0T4)  
    LECITHIN, SOYBEAN (UNII: 1DI56QDM62)  
    HYDROXYPROPYL CELLULOSE, LOW SUBSTITUTED (UNII: 2165RE0K14)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U)  
    POLYETHYLENE GLYCOL 4000 (UNII: 4R4HFI6D95)  
    POLYVINYL ALCOHOL (UNII: 532B59J990)  
    TALC (UNII: 7SEV7J4R1U)  
    TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
    FD&C BLUE NO. 2 (UNII: L06K8R7DQK)  
    FERROSOFERRIC OXIDE (UNII: XM0M87F357)  
    FERRIC OXIDE RED (UNII: 1K09F3G675)  
    Product Characteristics
    ColorpinkScoreno score
    ShapeOVAL (biconvex) Size10mm
    FlavorImprint Code J;12
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:31722-812-6060 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    2NDC:31722-812-18180 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    3NDC:31722-812-05500 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    4NDC:31722-812-32100 in 1 BLISTER PACK; Type 0: Not a Combination Product03/17/2022
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA20478703/17/2022
    LACOSAMIDE 
    lacosamide tablet, film coated
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:31722-813
    Route of AdministrationORALDEA ScheduleCV    
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    LACOSAMIDE (UNII: 563KS2PQY5) (LACOSAMIDE - UNII:563KS2PQY5) LACOSAMIDE100 mg
    Inactive Ingredients
    Ingredient NameStrength
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    CROSPOVIDONE (UNII: 68401960MK)  
    HYDROXYPROPYL CELLULOSE (UNII: RFW2ET671P)  
    HYPROMELLOSE 2910 (5 MPA.S) (UNII: R75537T0T4)  
    LECITHIN, SOYBEAN (UNII: 1DI56QDM62)  
    HYDROXYPROPYL CELLULOSE, LOW SUBSTITUTED (UNII: 2165RE0K14)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U)  
    POLYETHYLENE GLYCOL 4000 (UNII: 4R4HFI6D95)  
    POLYVINYL ALCOHOL (UNII: 532B59J990)  
    TALC (UNII: 7SEV7J4R1U)  
    TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
    FERRIC OXIDE YELLOW (UNII: EX438O2MRT)  
    Product Characteristics
    ColoryellowScoreno score
    ShapeOVAL (biconvex) Size13mm
    FlavorImprint Code J;13
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:31722-813-6060 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    2NDC:31722-813-18180 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    3NDC:31722-813-05500 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    4NDC:31722-813-32100 in 1 BLISTER PACK; Type 0: Not a Combination Product03/17/2022
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA20478703/17/2022
    LACOSAMIDE 
    lacosamide tablet
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:31722-814
    Route of AdministrationORALDEA ScheduleCV    
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    LACOSAMIDE (UNII: 563KS2PQY5) (LACOSAMIDE - UNII:563KS2PQY5) LACOSAMIDE150 mg
    Inactive Ingredients
    Ingredient NameStrength
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    CROSPOVIDONE (UNII: 68401960MK)  
    HYDROXYPROPYL CELLULOSE (UNII: RFW2ET671P)  
    HYPROMELLOSE 2910 (5 MPA.S) (UNII: R75537T0T4)  
    LECITHIN, SOYBEAN (UNII: 1DI56QDM62)  
    HYDROXYPROPYL CELLULOSE, LOW SUBSTITUTED (UNII: 2165RE0K14)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U)  
    POLYETHYLENE GLYCOL 4000 (UNII: 4R4HFI6D95)  
    POLYVINYL ALCOHOL (UNII: 532B59J990)  
    TALC (UNII: 7SEV7J4R1U)  
    TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
    FERRIC OXIDE YELLOW (UNII: EX438O2MRT)  
    FERROSOFERRIC OXIDE (UNII: XM0M87F357)  
    FERRIC OXIDE RED (UNII: 1K09F3G675)  
    Product Characteristics
    Colorpink (salmon color) Scoreno score
    ShapeOVAL (biconvex) Size15mm
    FlavorImprint Code J;14
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:31722-814-6060 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    2NDC:31722-814-18180 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    3NDC:31722-814-05500 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    4NDC:31722-814-32100 in 1 BLISTER PACK; Type 0: Not a Combination Product03/17/2022
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA20478703/17/2022
    LACOSAMIDE 
    lacosamide tablet, film coated
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:31722-815
    Route of AdministrationORALDEA ScheduleCV    
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    LACOSAMIDE (UNII: 563KS2PQY5) (LACOSAMIDE - UNII:563KS2PQY5) LACOSAMIDE200 mg
    Inactive Ingredients
    Ingredient NameStrength
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    CROSPOVIDONE (UNII: 68401960MK)  
    HYDROXYPROPYL CELLULOSE (UNII: RFW2ET671P)  
    HYPROMELLOSE 2910 (5 MPA.S) (UNII: R75537T0T4)  
    LECITHIN, SOYBEAN (UNII: 1DI56QDM62)  
    HYDROXYPROPYL CELLULOSE, LOW SUBSTITUTED (UNII: 2165RE0K14)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    CELLULOSE, MICROCRYSTALLINE (UNII: OP1R32D61U)  
    POLYETHYLENE GLYCOL 4000 (UNII: 4R4HFI6D95)  
    POLYVINYL ALCOHOL (UNII: 532B59J990)  
    TALC (UNII: 7SEV7J4R1U)  
    TITANIUM DIOXIDE (UNII: 15FIX9V2JP)  
    FD&C BLUE NO. 2 (UNII: L06K8R7DQK)  
    Product Characteristics
    ColorblueScoreno score
    ShapeOVAL (biconvex) Size16mm
    FlavorImprint Code J;15
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:31722-815-6060 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    2NDC:31722-815-18180 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    3NDC:31722-815-05500 in 1 BOTTLE; Type 0: Not a Combination Product03/17/2022
    4NDC:31722-815-32100 in 1 BLISTER PACK; Type 0: Not a Combination Product03/17/2022
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA20478703/17/2022
    Labeler - Camber Pharmaceuticals, Inc. (826774775)
    Establishment
    NameAddressID/FEIBusiness Operations
    Annora Pharma Private Limited650980746analysis(31722-812, 31722-813, 31722-814, 31722-815) , manufacture(31722-812, 31722-813, 31722-814, 31722-815)