Lacosamide dosing in patients receiving continuous renal replacement therapy.
Weerachai Chaijamorn1, Sathian Phunpon2, Thanompong Sathienluckana2
1Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Pathum Wan, Bangkok, 10330, Thailand. weerachai.c@pharm.chula.ac.th.
Journal of Intensive Care
|November 10, 2023
Summary
Optimal lacosamide dosing for critically ill patients on continuous renal replacement therapy (CRRT) was determined. Doses of 300-450 mg/day are recommended for standard CRRT, with higher doses for increased effluent rates.
Area of Science:
- Pharmacology
- Nephrology
- Critical Care Medicine
Background:
- Lacosamide is an anticonvulsant used in critically ill patients.
- Continuous renal replacement therapy (CRRT) is common in this population.
- Optimizing lacosamide dosing during CRRT is crucial for efficacy and safety.
Purpose of the Study:
- To determine appropriate lacosamide dosing regimens for critically ill patients undergoing CRRT.
- To utilize Monte Carlo simulations for dose optimization.
- To identify factors influencing lacosamide pharmacokinetics in this setting.
Main Methods:
- Developed mathematical models based on published pharmacokinetic data.
- Incorporated various CRRT modalities and effluent rates.
- Evaluated dosing regimens based on probability of target attainment (PTA) for specific concentration and exposure targets.
- Simulated 10,000 virtual patients per regimen.
Main Results:
- Recommended lacosamide dose of 300-450 mg/day for CRRT with 20-25 mL/kg/h effluent rates.
- Suggested 600 mg/day for higher effluent rates (35 mL/kg/h).
- Patients >100 kg were less likely to achieve target concentrations.
Conclusions:
- Volume of distribution, total clearance, CRRT clearance, and body weight significantly impact lacosamide dosing.
- Clinical validation of these simulated dosing regimens is essential.
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