Lacosamide

Identification

Summary

Lacosamide is an antiepileptic drug used to treat partial onset seizures in adults.

Brand Names
Vimpat
Generic Name
Lacosamide
DrugBank Accession Number
DB06218
Background

Lacosamide is a functionalized amino acid that has activity in the maximal electroshock seizure test, and is indicated for the adjunctive treatment of partial-onset seizures and diabetic neuropathic pain. Recent studies indicate that Lacosamide only affects those neurons which are depolarized or active for long periods of time, typical of neurons at the focus of an epileptic seizure, as opposed to other antiepileptic drugs such as carbamazepine or lamotrigine which slow the recovery from inactivation and reduce the ability of neurons to fire action potentials.

Type
Small Molecule
Groups
Approved
Structure
Thumb
Weight
Average: 250.2936
Monoisotopic: 250.131742452
Chemical Formula
C13H18N2O3
Synonyms
  • Erlosamide
  • Harkoseride
  • Lacosamida
  • Lacosamide
External IDs
  • ADD 243037
  • ADD-243037
  • SPM 927
  • SPM-927

Pharmacology

Indication

Lacosamide is indicated for adjunctive therapy for partial onset seizures in patients with epilepsy over 17 years old. Injection is indicated for short term use when oral therapy is not feasible.

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Associated Conditions
Contraindications & Blackbox Warnings
Contraindications
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Pharmacodynamics

Lacosamide therapy is correlated with a decrease in seizure frequency. It should be noted that in group analyses, dosages above 400 mg/day do not appear to result in additional benefit.

Mechanism of action

It is proposed that lacosamide's inhibition of sodium channels is responsible for analgesia. Lacosamide may be selective for inhibiting depolarized neurons rather than neurons with normal resting potentials. Pain and nociceptor hyperexcitability are associated with neural membrane depolarization. Lacosamide binds to collapsin response mediator protein-2 (CRMP-2), a phosphoprotein which is expressed primarily in the nervous system and is involved in neuronal differentiation and control of axonal outgrowth. The role CRMP-2 of binding in seizure control is hasn't been elucidated.

TargetActionsOrganism
USodium channel protein type 9 subunit alphaNot AvailableHumans
USodium channel protein type 3 subunit alphaNot AvailableHumans
USodium channel protein type 10 subunit alphaNot AvailableHumans
Absorption

Lacosamide has a negligible first pass effect with bioavailability of about 100%. The maximum Lacosamide plasma concentrations occur about 1-4 hours after oral administration, and the pharmacokinetics of Lacosamide are dose proportional. Food does not affect absorption.

Volume of distribution

approximately 0.6 L/kg; thus close to the volume of total body water.

Protein binding

<15%

Metabolism

Lacosamide is a CYP2C19 substrate. The relative contribution of other CYP isoforms or non-CYP enzymes in the metabolism of lacosamide is not known. Primary compounds excreted were unchanged lacosamide (approximately 40% of the dose), its O-desmethyl metabolite (approximately 30%), and a structurally unknown polar fraction (~20%). The plasma exposure of the major human metabolite, O-desmethyl-lacosamide, is approximately 10% of that of lacosamide. This metabolite has no known pharmacological activity.

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Route of elimination

Lacosamide is eliminated primarily from the systemic circulation by biotransformation and renal excretion.

Half-life

13 Hours

Clearance

95% recovered in the urine 0.5% in the feces

Adverse Effects
Adverseeffects
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Toxicity

Not Available

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Interacting Gene/EnzymeAllele nameGenotype(s)Defining Change(s)Type(s)DescriptionDetails
Cytochrome P450 2C19CYP2C19*2ANot Available681G>AEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*2BNot Available681G>AEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*3Not Available636G>AEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*4Not Available1A>GEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*5Not Available1297C>TEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*6Not Available395G>AEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*7Not Available19294T>AEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*22Not Available557G>C / 991A>GEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*24Not Available99C>T / 991A>G  … show all Effect InferredReduced O-desmethyl metabolite concentrations in plasma.Details
Cytochrome P450 2C19CYP2C19*35Not Available12662A>GEffect InferredReduced O-desmethyl metabolite concentrations in plasma.Details

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
1,2-BenzodiazepineThe risk or severity of adverse effects can be increased when Lacosamide is combined with 1,2-Benzodiazepine.
AbametapirThe serum concentration of Lacosamide can be increased when it is combined with Abametapir.
AbataceptThe metabolism of Lacosamide can be increased when combined with Abatacept.
AbemaciclibThe metabolism of Abemaciclib can be decreased when combined with Lacosamide.
AbirateroneThe metabolism of Lacosamide can be decreased when combined with Abiraterone.
AcalabrutinibThe metabolism of Acalabrutinib can be decreased when combined with Lacosamide.
AcebutololAcebutolol may increase the bradycardic activities of Lacosamide.
AcenocoumarolThe metabolism of Acenocoumarol can be decreased when combined with Lacosamide.
AcetaminophenThe metabolism of Lacosamide can be increased when combined with Acetaminophen.
AcetazolamideThe risk or severity of adverse effects can be increased when Acetazolamide is combined with Lacosamide.
Interactions
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Food Interactions
  • Take with or without food.

Products

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Product Images
Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
Alembic-lacosamideTablet100 mgOralAlembic Pharmaceuticals LimitedNot applicableNot applicableCanada flag
Alembic-lacosamideTablet200 mgOralAlembic Pharmaceuticals LimitedNot applicableNot applicableCanada flag
Alembic-lacosamideTablet50 mgOralAlembic Pharmaceuticals LimitedNot applicableNot applicableCanada flag
Alembic-lacosamideTablet150 mgOralAlembic Pharmaceuticals LimitedNot applicableNot applicableCanada flag
LacosamideTablet200 mgOralJubilant Generics LimitedNot applicableNot applicableCanada flag
LacosamideTablet50 mgOralJubilant Generics LimitedNot applicableNot applicableCanada flag
LacosamideTablet200 mgOralSanis Health IncNot applicableNot applicableCanada flag
LacosamideTablet50 mgOralSanis Health IncNot applicableNot applicableCanada flag
LacosamideTablet150 mgOralJubilant Generics LimitedNot applicableNot applicableCanada flag
LacosamideTablet150 mgOralSanis Health IncNot applicableNot applicableCanada flag
Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
Ach-lacosamideTablet100 mgOralAccord Healthcare Inc2021-04-27Not applicableCanada flag
Ach-lacosamideTablet200 mgOralAccord Healthcare Inc2021-04-27Not applicableCanada flag
Ach-lacosamideTablet50 mgOralAccord Healthcare Inc2021-04-27Not applicableCanada flag
Ach-lacosamideTablet150 mgOralAccord Healthcare Inc2021-04-27Not applicableCanada flag
Ag-lacosamideTablet100 mgOralAngita Pharma Inc.Not applicableNot applicableCanada flag
Ag-lacosamideTablet200 mgOralAngita Pharma Inc.Not applicableNot applicableCanada flag
Ag-lacosamideTablet50 mgOralAngita Pharma Inc.Not applicableNot applicableCanada flag
Ag-lacosamideTablet150 mgOralAngita Pharma Inc.Not applicableNot applicableCanada flag
Apo-lacosamideTablet100 mgOralApotex CorporationNot applicableNot applicableCanada flag
Apo-lacosamideTablet200 mgOralApotex CorporationNot applicableNot applicableCanada flag
Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
ELEPSİ 50 MG+100 MG TEDAVİYE BAŞLAMA PAKETİ, 42 ADETLacosamide (50 mg) + Lacosamide (100 mg)Tablet, film coatedOralSANTA FARMA İLAÇ SAN. A.Ş.2020-08-14Not applicableTurkey flag
ELEPSİ 50 MG+100 MG TEDAVİYE BAŞLAMA PAKETİ, 42 ADETLacosamide (50 mg) + Lacosamide (100 mg)Tablet, film coatedOralSANTA FARMA İLAÇ SAN. A.Ş.2020-08-14Not applicableTurkey flag
LAMIDE TEDAVIYE BAŞLAMA PAKETI, 56 ADETLacosamide (50 mg) + Lacosamide (100 mg) + Lacosamide (150 mg) + Lacosamide (200 mg)Tablet, film coatedOralALİ RAİF İLAÇ SAN. A.Ş.2020-08-14Not applicableTurkey flag
LAMIDE TEDAVIYE BAŞLAMA PAKETI, 56 ADETLacosamide (50 mg) + Lacosamide (100 mg) + Lacosamide (150 mg) + Lacosamide (200 mg)Tablet, film coatedOralALİ RAİF İLAÇ SAN. A.Ş.2020-08-14Not applicableTurkey flag
LAMIDE TEDAVIYE BAŞLAMA PAKETI, 56 ADETLacosamide (50 mg) + Lacosamide (100 mg) + Lacosamide (150 mg) + Lacosamide (200 mg)Tablet, film coatedOralALİ RAİF İLAÇ SAN. A.Ş.2020-08-14Not applicableTurkey flag
LAMIDE TEDAVIYE BAŞLAMA PAKETI, 56 ADETLacosamide (50 mg) + Lacosamide (100 mg) + Lacosamide (150 mg) + Lacosamide (200 mg)Tablet, film coatedOralALİ RAİF İLAÇ SAN. A.Ş.2020-08-14Not applicableTurkey flag
VimpatLacosamide (50 mg/1) + Lacosamide (100 mg/1)OralUCB, Inc.2009-05-26Not applicableUS flag
VimpatLacosamide (50 mg/1) + Lacosamide (100 mg/1)OralUCB, Inc.2009-05-26Not applicableUS flag

Categories

ATC Codes
N03AX18 — Lacosamide
Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
This compound belongs to the class of organic compounds known as n-acyl-alpha amino acids and derivatives. These are compounds containing an alpha amino acid (or a derivative thereof) which bears an acyl group at its terminal nitrogen atom.
Kingdom
Organic compounds
Super Class
Organic acids and derivatives
Class
Carboxylic acids and derivatives
Sub Class
Amino acids, peptides, and analogues
Direct Parent
N-acyl-alpha amino acids and derivatives
Alternative Parents
Alpha amino acid amides / Benzene and substituted derivatives / Acetamides / Secondary carboxylic acid amides / Dialkyl ethers / Organopnictogen compounds / Organonitrogen compounds / Organic oxides / Hydrocarbon derivatives / Carbonyl compounds
Substituents
Acetamide / Alpha-amino acid amide / Aromatic homomonocyclic compound / Benzenoid / Carbonyl group / Carboxamide group / Dialkyl ether / Ether / Hydrocarbon derivative / Monocyclic benzene moiety
Molecular Framework
Aromatic homomonocyclic compounds
External Descriptors
Not Available
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
563KS2PQY5
CAS number
175481-36-4
InChI Key
VPPJLAIAVCUEMN-GFCCVEGCSA-N
InChI
InChI=1S/C13H18N2O3/c1-10(16)15-12(9-18-2)13(17)14-8-11-6-4-3-5-7-11/h3-7,12H,8-9H2,1-2H3,(H,14,17)(H,15,16)/t12-/m1/s1
IUPAC Name
(2R)-N-benzyl-2-acetamido-3-methoxypropanamide
SMILES
COC[C@@H](NC(C)=O)C(=O)NCC1=CC=CC=C1

References

Synthesis Reference

http://www.google.com/patents?id=IIanAAAAEBAJ&pg=PA2&source=gbsselectedpages&cad=3#v=onepage&q&f=false

General References
  1. Sheets PL, Heers C, Stoehr T, Cummins TR: Differential block of sensory neuronal voltage-gated sodium channels by lacosamide [(2R)-2-(acetylamino)-N-benzyl-3-methoxypropanamide], lidocaine, and carbamazepine. J Pharmacol Exp Ther. 2008 Jul;326(1):89-99. doi: 10.1124/jpet.107.133413. Epub 2008 Mar 31. [Article]
  2. Jones GL, Popli GS, Silvia MT: Lacosamide-induced valproic acid toxicity. Pediatr Neurol. 2013 Apr;48(4):308-10. doi: 10.1016/j.pediatrneurol.2012.12.039. [Article]
KEGG Drug
D07299
PubChem Compound
219078
PubChem Substance
175427063
ChemSpider
189902
BindingDB
50300204
RxNav
623400
ChEBI
135939
ChEMBL
CHEMBL58323
ZINC
ZINC000000007673
PharmGKB
PA166160048
Wikipedia
Lacosamide
FDA label
Download (276 KB)
MSDS
Download (570 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
4CompletedTreatmentAcute Kidney Injury (AKI) / Impaired Renal Function / Kidney Failure / Pharmacokinetics1
4CompletedTreatmentEpilepsies2
4CompletedTreatmentEpilepsy, Localization Related4
4RecruitingPreventionEpilepsy, Intractable / Gliomas, Malignant / Seizures Disorders1
4RecruitingTreatmentEpilepsies1
4TerminatedTreatmentSeizures1
3Active Not RecruitingTreatmentEpilepsies2
3CompletedTreatmentDiabetic Neuropathies2
3CompletedTreatmentDiabetic Neuropathy, Painful; Diabetic Neuropathies2
3CompletedTreatmentEpilepsies10

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
InjectionIntravenous
SyrupOral1 g
Tablet, coatedOral150 mg
SolutionParenteral
SyrupOral
Tablet, film coatedOral
Kit; tablet, film coatedOral
Tablet, coatedOral200 mg
SolutionOral10 mg/1mL
Tablet, film coatedOral100 mg/1
Tablet, film coatedOral150 mg/1
Tablet, film coatedOral200 mg/1
Tablet, film coatedOral100 MG
Tablet, film coatedOral150 MG
Tablet, film coatedOral50 MG
Injection, solutionIntravenous
TabletOral150 mg
Tablet, film coatedOral
InjectionIntravenous10 mg/1mL
SolutionIntravenous10 mg / mL
SyrupOral10 MG/ML
SyrupOral15 MG/ML
TabletOral100 mg
TabletOral200 mg
TabletOral50 mg
Tablet, coatedOral
Tablet, film coatedOral50 mg/1
SolutionOral1000 mg
Tablet, coatedOral100 mg
Tablet, coatedOral50 mg
SyrupOral15 mg
SyrupOral10 mg/1ml
Tablet, film coatedOral200 mg
SolutionIntravenous200 mg
Injection, solutionIntravenous10 mg/ml
Prices
Not Available
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US5654301No1997-08-052014-08-05US flag
USRE38551No2004-07-062022-03-17US flag

Properties

State
Solid
Experimental Properties
PropertyValueSource
melting point (°C)140-146˚Chttp://www.ema.europa.eu/docs/en_GB/document_library/Application_withdrawal_assessment_report/2010/01/WC500064326.pdf
boiling point (°C)536.447 °C at 760 mmHgACD/Labs
water solubilityLacosamide is a white to light yellow powder. It is sparingly soluble in water and slightly soluble in acetonitrile and ethanol.FDA Label
logP0.728ACD/Labs
Predicted Properties
PropertyValueSource
Water Solubility0.465 mg/mLALOGPS
logP0.18ALOGPS
logP-0.022ChemAxon
logS-2.7ALOGPS
pKa (Strongest Acidic)12.47ChemAxon
pKa (Strongest Basic)-1.5ChemAxon
Physiological Charge0ChemAxon
Hydrogen Acceptor Count3ChemAxon
Hydrogen Donor Count2ChemAxon
Polar Surface Area67.43 Å2ChemAxon
Rotatable Bond Count6ChemAxon
Refractivity67.57 m3·mol-1ChemAxon
Polarizability26.68 Å3ChemAxon
Number of Rings1ChemAxon
Bioavailability1ChemAxon
Rule of FiveYesChemAxon
Ghose FilterYesChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET Features
PropertyValueProbability
Human Intestinal Absorption+0.9771
Blood Brain Barrier+0.7181
Caco-2 permeable-0.6886
P-glycoprotein substrateSubstrate0.7158
P-glycoprotein inhibitor INon-inhibitor0.6904
P-glycoprotein inhibitor IINon-inhibitor0.8878
Renal organic cation transporterNon-inhibitor0.8757
CYP450 2C9 substrateNon-substrate0.8732
CYP450 2D6 substrateNon-substrate0.7634
CYP450 3A4 substrateNon-substrate0.6572
CYP450 1A2 substrateNon-inhibitor0.8084
CYP450 2C9 inhibitorNon-inhibitor0.8704
CYP450 2D6 inhibitorNon-inhibitor0.8775
CYP450 2C19 inhibitorNon-inhibitor0.8201
CYP450 3A4 inhibitorNon-inhibitor0.837
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.9732
Ames testNon AMES toxic0.7694
CarcinogenicityNon-carcinogens0.8388
BiodegradationNot ready biodegradable0.8499
Rat acute toxicity2.1629 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.9678
hERG inhibition (predictor II)Non-inhibitor0.8489
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)
Download (18.4 KB)
Spectra
SpectrumSpectrum TypeSplash Key
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSNot Available
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSNot Available

Targets

Drugtargets2
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Kind
Protein
Organism
Humans
Pharmacological action
Unknown
General Function
Voltage-gated sodium channel activity
Specific Function
Mediates the voltage-dependent sodium ion permeability of excitable membranes. Assuming opened or closed conformations in response to the voltage difference across the membrane, the protein forms a...
Gene Name
SCN9A
Uniprot ID
Q15858
Uniprot Name
Sodium channel protein type 9 subunit alpha
Molecular Weight
226370.175 Da
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
General Function
Voltage-gated sodium channel activity
Specific Function
Mediates the voltage-dependent sodium ion permeability of excitable membranes. Assuming opened or closed conformations in response to the voltage difference across the membrane, the protein forms a...
Gene Name
SCN3A
Uniprot ID
Q9NY46
Uniprot Name
Sodium channel protein type 3 subunit alpha
Molecular Weight
226291.905 Da
References
  1. Berman HM, Westbrook J, Feng Z, Gilliland G, Bhat TN, Weissig H, Shindyalov IN, Bourne PE: The Protein Data Bank. Nucleic Acids Res. 2000 Jan 1;28(1):235-42. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
General Function
Voltage-gated sodium channel activity
Specific Function
Tetrodotoxin-resistant channel that mediates the voltage-dependent sodium ion permeability of excitable membranes. Assuming opened or closed conformations in response to the voltage difference acro...
Gene Name
SCN10A
Uniprot ID
Q9Y5Y9
Uniprot Name
Sodium channel protein type 10 subunit alpha
Molecular Weight
220623.605 Da
References
  1. Berman HM, Westbrook J, Feng Z, Gilliland G, Bhat TN, Weissig H, Shindyalov IN, Bourne PE: The Protein Data Bank. Nucleic Acids Res. 2000 Jan 1;28(1):235-42. [Article]

Enzymes

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Substrate
General Function
Steroid hydroxylase activity
Specific Function
Responsible for the metabolism of a number of therapeutic agents such as the anticonvulsant drug S-mephenytoin, omeprazole, proguanil, certain barbiturates, diazepam, propranolol, citalopram and im...
Gene Name
CYP2C19
Uniprot ID
P33261
Uniprot Name
Cytochrome P450 2C19
Molecular Weight
55930.545 Da
References
  1. Contin M, Albani F, Riva R, Candela C, Mohamed S, Baruzzi A: Lacosamide therapeutic monitoring in patients with epilepsy: effect of concomitant antiepileptic drugs. Ther Drug Monit. 2013 Dec;35(6):849-52. doi: 10.1097/FTD.0b013e318290eacc. [Article]
  2. Bentue-Ferrer D, Tribut O, Verdier MC: [Therapeutic drug monitoring of lacosamide]. Therapie. 2012 Mar-Apr;67(2):151-5. doi: 10.2515/therapie/2012012. Epub 2012 Aug 2. [Article]
  3. Chung SS: New treatment option for partial-onset seizures: efficacy and safety of lacosamide. Ther Adv Neurol Disord. 2010 Mar;3(2):77-83. doi: 10.1177/1756285609355850. [Article]
  4. Drugs.com Lacosamide Monograph [Link]
  5. FDA Approved Drug Products: VIMPAT (lacosamide) for oral or intravenous use [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Steroid hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
Gene Name
CYP2C9
Uniprot ID
P11712
Uniprot Name
Cytochrome P450 2C9
Molecular Weight
55627.365 Da
References
  1. FDA Approved Drug Products: VIMPAT (lacosamide) for oral or intravenous use [Link]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. FDA Approved Drug Products: VIMPAT (lacosamide) for oral or intravenous use [Link]

Drug created on March 19, 2008 16:17 / Updated on September 19, 2021 19:53