When Lacosamide Isn't Available, What Are Your Options?

If you depend on Lacosamide to manage your seizures and suddenly can't fill your prescription, it's natural to feel anxious. Seizure medications aren't something you can just skip — missing doses can lead to breakthrough seizures, which can be dangerous.

The first thing to do is try to find Lacosamide at another pharmacy. Tools like Medfinder can help you locate pharmacies that have it in stock. But if you've exhausted those options and need a plan B, it's worth knowing what alternatives exist.

Important: Never switch seizure medications on your own. Always work with your doctor or neurologist to make any changes. Switching AEDs requires careful dosing adjustments and monitoring.

What Is Lacosamide and How Does It Work?

Lacosamide (brand name Vimpat) is an antiepileptic drug that controls seizures by selectively enhancing the slow inactivation of voltage-gated sodium channels in the brain. This is a slightly different mechanism than older sodium channel blockers, which primarily affect fast inactivation.

It's FDA-approved for focal (partial-onset) seizures and primary generalized tonic-clonic seizures. Most patients take 100 mg to 200 mg twice daily. For more details, see our full overview: What Is Lacosamide?

Understanding how Lacosamide works helps explain which alternatives might be suitable — your doctor will look for drugs with similar mechanisms or ones that treat the same seizure types.

Alternative 1: Oxcarbazepine (Trileptal)

Oxcarbazepine is a sodium channel blocker commonly used for focal seizures in adults and children. It's one of the closest alternatives to Lacosamide in terms of mechanism.

• How it works: Blocks voltage-gated sodium channels (primarily fast inactivation) and modulates calcium channels
• FDA-approved for: Focal seizures (monotherapy and adjunctive) in adults and children age 2+
• Typical dose: 600 mg to 2,400 mg per day, divided into two doses
• Key differences: More drug interactions than Lacosamide (enzyme induction); can cause low sodium levels (hyponatremia); available as a very affordable generic
• Generic price: As low as $10-$30 per month with a discount coupon

Alternative 2: Carbamazepine (Tegretol)

Carbamazepine is one of the oldest and most well-studied antiepileptic drugs. It's a first-line treatment for focal seizures and has been around for decades.

• How it works: Blocks voltage-gated sodium channels (fast inactivation)
• FDA-approved for: Focal seizures, generalized tonic-clonic seizures, trigeminal neuralgia, and bipolar disorder
• Typical dose: 400 mg to 1,200 mg per day, divided into two to four doses
• Key differences: Significant drug interactions (potent CYP3A4 inducer); requires blood monitoring; risk of serious skin reactions (Stevens-Johnson syndrome) — HLA-B*1502 genetic testing recommended in patients of Asian ancestry; very affordable generic
• Generic price: As low as $5-$15 per month

Alternative 3: Eslicarbazepine (Aptiom)

Eslicarbazepine is a newer sodium channel blocker related to Oxcarbazepine. It offers the convenience of once-daily dosing.

• How it works: Blocks voltage-gated sodium channels (enhances slow inactivation, similar to Lacosamide)
• FDA-approved for: Focal seizures (monotherapy and adjunctive) in adults and children age 4+
• Typical dose: 800 mg to 1,600 mg once daily
• Key differences: Once-daily dosing is convenient; mechanism is arguably the most similar to Lacosamide among these alternatives; still mostly brand-name, so it's more expensive
• Price: Brand-name Aptiom can cost $1,000+ per month without insurance; limited generic availability

Alternative 4: Levetiracetam (Keppra)

Levetiracetam has a completely different mechanism than Lacosamide, but it's one of the most widely prescribed AEDs and is effective for many of the same seizure types.

• How it works: Binds to synaptic vesicle protein SV2A — a unique mechanism different from sodium channel blockers
• FDA-approved for: Focal seizures, myoclonic seizures, and primary generalized tonic-clonic seizures
• Typical dose: 1,000 mg to 3,000 mg per day, divided into two doses
• Key differences: Very few drug interactions; no cardiac conduction concerns; common side effect is irritability or mood changes; extremely affordable generic
• Generic price: As low as $5-$15 per month

How Your Doctor Will Choose an Alternative

Your neurologist will consider several factors when selecting a replacement:

• Your seizure type: Focal seizures, generalized seizures, or both
• Other medications: Drug interactions matter — Lacosamide has relatively few, so your doctor will want to avoid introducing new interaction risks
• Side effect history: If you've tried and failed other AEDs before, your doctor will take that into account
• Heart health: Lacosamide can affect heart rhythm (PR prolongation). If cardiac issues are a concern, your doctor may choose an alternative with a different cardiac profile
• Cost and insurance: Some alternatives are much cheaper than others

Final Thoughts

Not being able to fill your Lacosamide prescription is stressful, but you're not without options. Before switching to a different medication, try using Medfinder to find Lacosamide at a nearby pharmacy. If a switch is truly necessary, work closely with your doctor to find the best alternative for your specific situation.

For more information, read our articles on Lacosamide drug interactions and Lacosamide side effects.