Lacosamide: Package Insert and Label Information (Page 2 of 5)

5.5 Withdrawal of Antiepileptic Drugs (AEDs)

As with all AEDs, Lacosamide oral solution should be withdrawn gradually (over a minimum of 1 week) to minimize the potential of increased seizure frequency in patients with seizure disorders.

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 oral solution. 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 oral solution should be discontinued if an alternative etiology for the signs or symptoms cannot be established.

5.7 Risks in Patients with Phenylketonuria

Phenylalanine can be harmful in patients with phenylketonuria (PKU). Lacosamide oral solution contains aspartame, a source of phenylalanine. A 200 mg dose of Lacosamide oral solution (equivalent to 20 mL) contains 0.50 mg of phenylalanine. Before prescribing Lacosamide oral solution to a patient with PKU, consider the combined daily amount of phenylalanine from all sources, including Lacosamide oral solution.

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 Reactions [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 Oral Solution in Adult

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 oral solution 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 post-marketing experience [see 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 oral solution 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 Oral Solution 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 Oral Solution 200 mg/day N=270 %	Lacosamide Oral Solution 400 mg/day N=471 %	Lacosamide Oral Solution 600mg/day* N=203 %	Lacosamide Oral Solution Total N=944 %
Ear and labyrinth disorder
Vertigo	1	5	3	4	4
Eye disorders
Diplopia	2	6	10	16	11
Blurred Vision	3	2	9	16	8
Gastrointestinal disorders
Nausea	4	7	11	17	11
Vomiting	3	6	9	16	9
Diarrhea	3	3	5	4	4
General disorders and administration site conditions
Fatigue	6	7	7	15	9
Gait disturbance	<1	<1	2	4	2
Asthenia	1	2	2	4	2
Injury, poisoning and procedural complications
Contusion	3	3	4	2	3
Skin laceration	2	2	3	3	3
Nervous system disorders
Dizziness	8	16	30	53	31
Headache	9	11	14	12	13
Ataxia	2	4	7	15	8
Somnolence	5	5	8	8	7
Tremor	4	4	6	12	7
Nystagmus	4	2	5	10	5
Balance disorder	0	1	5	6	4
Memory impairment	2	1	2	6	2
Psychiatric disorders
Depression	1	2	2	2	2
Skin and subcutaneous disorders
Pruritus	1	3	2	3	2

*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 Oral Solution in Pediatric Patients

Safety of lacosamide oral solution 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 oral solution 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 oral solution 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 oral solution 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 oral solution 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 oral solution.

Other Adverse Reactions

The following is a list of adverse reactions reported by patients treated with lacosamide oral solution 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) oral solution. However, due to UCB, Inc.’s marketing exclusivity rights, this drug product is not labeled with that pediatric information.