When You Can't Get Vimpat, What Are Your Options?

If you've been prescribed Vimpat (Lacosamide) for partial-onset seizures and you're having trouble filling your prescription, you might be wondering: are there other medications that could work for me?

The short answer is yes — there are several well-established alternatives. But switching seizure medications is never something you should do on your own. Any change needs to be guided by your neurologist, who can evaluate your seizure type, medical history, and other medications to find the safest option.

This article will help you understand how Vimpat works, introduce some common alternatives, and give you the information you need to have a productive conversation with your doctor.

What Is Vimpat and How Does It Work?

Vimpat is the brand name for Lacosamide, an antiepileptic drug (AED) manufactured by UCB Pharma. It's FDA-approved as both monotherapy and adjunctive therapy for partial-onset (focal) seizures in patients 1 month of age and older.

Vimpat works differently from most other seizure medications. While many AEDs block the fast inactivation of sodium channels, Vimpat selectively enhances slow inactivation of voltage-gated sodium channels. This unique mechanism helps reduce abnormal electrical activity in the brain without completely shutting down normal nerve signaling.

Vimpat is typically taken twice daily, with doses ranging from 100 mg to 400 mg per day. It's available as tablets, an oral solution, and an IV formulation. It's classified as a Schedule V controlled substance.

For a deeper dive into how this medication works, check out our article on Vimpat's mechanism of action.

Why Might You Need an Alternative?

There are several reasons you might need to explore alternatives to Vimpat:

• Availability issues — your pharmacy can't get it in stock (learn more about why Vimpat can be hard to find)
• Cost concerns — even generic Lacosamide may be too expensive without insurance
• Side effects — dizziness, double vision, or cardiac concerns may require a switch (read about Vimpat side effects)
• Inadequate seizure control — Vimpat isn't fully controlling your seizures
• Drug interactions — Vimpat may interact with other medications you take (see our drug interactions guide)

Alternative Medications to Vimpat

The following medications are commonly used for partial-onset seizures and may be considered as alternatives to Vimpat. Each has its own benefits and trade-offs.

1. Brivaracetam (Briviact)

Brivaracetam is a newer antiepileptic drug approved for partial-onset seizures in patients 1 month and older. It works by binding to synaptic vesicle protein 2A (SV2A) in the brain — a completely different mechanism from Vimpat.

Key points:

• Available as tablets, oral solution, and IV injection
• Typical dose: 50 mg to 200 mg per day (taken twice daily)
• Generally well-tolerated with fewer drug interactions than many AEDs
• Common side effects include drowsiness, dizziness, and fatigue
• Brand-name cost is high, but it may be a good option if Vimpat causes cardiac-related side effects since Briviact does not affect the PR interval

2. Oxcarbazepine (Trileptal)

Oxcarbazepine is an established sodium channel blocker used for partial seizures. It's been available for decades, and generic versions are widely accessible.

Key points:

• Available as tablets, extended-release tablets (Oxtellar XR), and oral suspension
• Typical dose: 600 mg to 2,400 mg per day
• Generic cost: approximately $15 to $60 per month, making it one of the most affordable options
• Common side effects include dizziness, drowsiness, double vision, and low sodium (hyponatremia)
• More drug interactions than Vimpat — can affect hormonal birth control and other medications

3. Levetiracetam (Keppra)

Levetiracetam is one of the most widely prescribed AEDs in the world. It treats both partial-onset and some generalized seizures, and it's available as an affordable generic.

Key points:

• Available as tablets, extended-release tablets, oral solution, and IV injection
• Typical dose: 1,000 mg to 3,000 mg per day (taken twice daily)
• Generic cost: as low as $10 to $30 per month
• Minimal drug interactions — a major advantage for patients on multiple medications
• Common side effects include drowsiness, weakness, and behavioral changes (irritability, mood swings) — sometimes called "Keppra rage"
• Very widely stocked at virtually every pharmacy

4. Zonisamide (Zonegran)

Zonisamide is approved as adjunctive therapy for partial seizures in adults. It works through multiple mechanisms, including blocking sodium and calcium channels.

Key points:

• Available as capsules
• Typical dose: 100 mg to 400 mg per day (can be taken once daily)
• Generic cost: approximately $15 to $50 per month
• Common side effects include drowsiness, loss of appetite, dizziness, and kidney stones (rare)
• Should be avoided in patients with sulfa allergies
• Once-daily dosing can be more convenient

How to Talk to Your Doctor About Switching

If you're considering an alternative to Vimpat, here's how to approach the conversation:

1. Explain the reason — whether it's availability, cost, side effects, or something else
2. Ask about tapering — you should never stop Vimpat suddenly. Your doctor will create a gradual dose reduction plan while starting the new medication.
3. Discuss your seizure history — how well controlled are your seizures? Have you tried other AEDs before?
4. Consider the transition period — switching AEDs can temporarily increase seizure risk. Plan for extra precautions during this time.

If availability is your main issue, also try finding Vimpat in stock near you before making a switch — the medication may be available at a different pharmacy.

Final Thoughts

Vimpat is an effective seizure medication, but it's not the only option. If you can't fill your prescription — whether due to supply issues, cost, or side effects — alternatives like Briviact, Trileptal, Keppra, and Zonegran are worth discussing with your neurologist.

Every person with epilepsy is different, and what works for one patient may not work for another. The most important thing is to never change or stop your seizure medication without medical guidance. Work with your doctor to find the safest path forward.

In the meantime, check Medfinder to see if Vimpat is available at a pharmacy near you — you might find it closer than you think.