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KMID : 0869620230400040433
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Journal of Korean Society of Hospital Pharmacists
2023 Volume.40 No. 4 p.433 ~ p.448
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Analysis of Cardiac Rhythm and Conduction Abnormalities Associated with Intravenous Lacosamide Administration
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Kim Min-Kyoung
Kim Keon-Hee
Cho Chong-Woon
Choi Kyung-Sook
Lee Jeong-Hwa
Lee Ju-Yeun
Lee Euni
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Abstract
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Background : Cardiac rhythm and conduction abnormalities related to lacosamide are described in the approved package insert. However, reports of the safety issues related to intravenous lacosamide are scarce in clinical practice. Therefore, this study aimed to describe the prevalence of cardiac rhythm and conduction abnormalities and evaluate factors associated with safety outcomes after intravenous lacosamide administration.
Methods : We reviewed the electronic medical records of all prescriptions for patients over the age of 16 years old who received intravenous lacosamide at the Seoul National University Bundang Hospital from June 2019 and May 2022. Demographic characteristics and information related to dosage, purpose, and concomitant medications were collected. Heart rates, electrocardiography (ECG) findings, and PR intervals were compared before and after lacosamide administration to evaluate cardiac rhythm and conduction abnormalities.
Results : A total of 317 prescriptions were identified. The average age of the patients was 56.3 years (SD 18.1) and 50.2% were male. The prevalence of bradycardia and ECG abnormalities was 5.6% and 6.3%, respectively. Of the 70 prescriptions having records of PR intervals before and after lacosamide administration, the rate of PR prolongation was 12.9%. Heart rate was significantly decreased (from 76.3 beats/min to 62.8 beats/min) and PR intervals were increased (from 162.5 ms to 171.8 ms) after lacosamide administration. Findings from the multivariate logistic regression analysis showed that underlying heart disease (adjusted odds ratio [ORadj]=3.22, 95% CI 1.11-9.23), concomitant prescription for lorazepam (ORadj= 3.25, 95% CI 1.44-7.56), and concomitant prescription for valproate (ORadj=3.11, 95% CI 1.35-7.20) were predictive factors of cardiac rhythm and conduction abnormalities.
Conclusion : Cardiac rhythm and conduction abnormalities were observed after intravenous lacosamide administration. Underlying heart disease and concomitant medications were associated with safety outcomes. A larger scale study is needed to confirm the cardiac rhythm and conduction abnormalities found in this study.
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KEYWORD
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Lacosamide, Cardiac safety, PR interval, Sinus bradycardia, Atrial fibrillation
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