Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
Postgraduate School of Pharmacology and Clinical Toxicology, University of Pavia, Pavia, Italy.
Br J Clin Pharmacol. 2024 Mar;90(3):812-818. doi: 10.1111/bcp.15964. Epub 2023 Nov 29.
Lacosamide is a third-generation antiepileptic drug used as adjunctive therapy for partial seizures. Since its approval in 2008 very few cases of lacosamide overdose have been described in literature. The aim of our study was to evaluate clinical characteristics of acute lacosamide poisoning.
A retrospective observational study was performed including all cases of acute lacosamide poisoning referred to Pavia Poison Control Centre from January 2012 to December 2021. For each patient age, sex, ingested dose, coingestants, clinical manifestations, treatment and outcome were collected.
A total of 31 subjects (median age 39 years, [interquartile range: 26.5-46.5]; females 22/31) were included. The median lacosamide ingested dose was 1500 mg [650-2800]. In 35.5% of cases lacosamide was the single ingested substance, while in 64.5% coingestants were also present. Coingestants varied from a minimum of 1 to a maximum of 3, with the more common being benzodiazepines and valproic acid. Clinical manifestations were present in 87% patients the most common were: vomiting (29%); seizures (29%), coma (25.8%), drowsiness (25.8%), confusion (12.9%), agitation (12.9%), tachycardia (12.9%), tremors (9.7%), bradycardia (9.7%), headache (6.5%) and hypertension (3.2%). The median lacosamide ingested dose was significantly higher in patients that experienced coma compared to patient who did not (2800 vs. 800 mg; P = .0082). Orotracheal intubation was necessary in 32.3% of patients. All patients fully recovered.
Lacosamide acute overdose may lead to a severe clinical picture. Dentral nervous system symptoms predominated, particularly seizures and coma occurred in a high percentage of cases.
拉科酰胺是一种第三代抗癫痫药物，用作部分发作的辅助治疗。自 2008 年批准以来，文献中很少有拉科酰胺过量的病例描述。我们研究的目的是评估急性拉科酰胺中毒的临床特征。
进行了一项回顾性观察研究，纳入了 2012 年 1 月至 2021 年 12 月期间向帕维亚中毒控制中心转诊的所有急性拉科酰胺中毒病例。收集了每位患者的年龄、性别、摄入剂量、共服药物、临床表现、治疗和结局。
共纳入 31 名患者（中位年龄 39 岁[四分位距：26.5-46.5]；女性 22/31）。拉科酰胺的中位摄入剂量为 1500mg[650-2800]。在 35.5%的病例中，拉科酰胺是唯一摄入的物质，而在 64.5%的病例中存在共服药物。共服药物从 1 种到 3 种不等，最常见的是苯二氮䓬类药物和丙戊酸。87%的患者存在临床表现，最常见的是：呕吐（29%）；癫痫发作（29%），昏迷（25.8%），嗜睡（25.8%），意识混乱（12.9%），激越（12.9%），心动过速（12.9%），震颤（9.7%），心动过缓（9.7%），头痛（6.5%）和高血压（3.2%）。与未发生昏迷的患者相比，发生昏迷的患者摄入的拉科酰胺剂量明显更高（2800 与 800mg；P=0.0082）。32.3%的患者需要进行经口气管插管。所有患者均完全康复。
急性拉科酰胺过量可能导致严重的临床症状。中枢神经系统症状为主，特别是癫痫发作和昏迷的发生率较高。
