Pain Amelioration in Patients with Neuropathic Pain: An Emerging Role of Lacosamide besides its Role as an Anti Epileptic Agent

I read with great interest the recent article by Shah et al. [1] Interestingly, the past few years have seen the emergence of lacosamide as a novel new agent in the management of neuropathy associated pain besides its role in managing seizures.

For instance, lacosamide is effective in ameliorating pain secondary to neuropathies induced by chemotherapeutic agents such as vincristine [2] Lacosamide at a daily dose of 400 milligrams is also effective in decreasing pain associated with diabetic neuropathy [3] Lacosamide is also effective in the treatment of pain associated with trigeminal neuralgias [4] Lacosamide induces these anti- nociceptive effects by accentuating the slow inactivation of voltage gated sodium channels in neurons [5] In fact, recent studies show that lacosamide appears to be more effective in ameliorating neuropathic pain in comparison to agents such as pregabalin.

Besides this, lacosamide has also been shown to attenuate hyperalgesia in patients with pain syndromes such as Dejerine-Roussy syndrome [6] Lacosamide also attenuates osteoarthritis associated pain [7] Interestingly, lacosamide seems to be more effective in ameliorating pain in female animal models in comparison to male animal models [3]

Intravenous lacosamide is a faster alternative for pain relief in comparison to oral lacosamide [6] Side effects associated with locasamide are relatively few. In fact, Wymer et al. in a recent study reported that only 8% of patients administered locasamide for neuropathic pain abandoned the study due to side affects of the drug [8] Clearly, further studies are needed to confirm these analgesic effects of lacosamide. The coming few years may very well see the emergence of lacosamide as a potent agent for control of neuropathic pain besides its role in controlling seizures.

• References

• 1 Shah S, Vasantharaju SG, Arumugam K et al. Development of a Sensitive Bioanalytical Method for the Quantification of Lacosamide in Rat Plasma. Application to Preclinical Pharmacokinetics Studies in Rats
• 2 Geis C, Beyreuther BK, Stohr T et al. Lacosamide has protective disease modifying properties in experimental vincristine neuropathy. Neuropharmacology 2011; 61: 600-607
• 3 Shaibani A, Fares S, Selam JL et al. Lacosamide in painful diabetic neuropathy: an 18-week double-blind placebo-controlled trial. J Pain 2009; 10: 818-828
• 4 Hao JX, Stohr T, Selve N et al. Lacosamide, a new anti-epileptic, alleviates neuropathic pain-like behaviors in rat models of spinal cord or trigeminal nerve injury. Eur J Pharmacol 2006; 553: 135-140
• 5 Errington AC, Stohr T, Heers C et al. The investigational anticonvulsant lacosamide selectively enhances slow inactivation of voltage-gated sodium channels. Mol Pharmacol 2008; 73: 157-169
• 6 Garcia-Escriva A, Lopez-Hernandez N, Gil-Cortes C. Treatment of neuropathic pain with lacosamide. Rev Neurol 2012; 54: 167-172
• 7 Beyreuther B, Callizot N, Stohr T. Antinociceptive efficacy of lacosamide in the monosodium iodoacetate rat model for osteoarthritis pain. Arthritis Res Ther 2007; 9: R14
• 8 Wymer JP, Simpson J, Sen D et al. Lacosamide SP742 Study Group. Efficacy and safety of lacosamide in diabetic neuropathic pain: an 18-week double-blind placebo-controlled trial of fixed-dose regimens. Clin J Pain 2009; 25: 376-385