# Influence of age and antiepileptic comedication on lacosamide concentrations in children with epilepsy: A retrospective cohort study

## TL;DR

This study examines how age and other medications affect lacosamide levels in children with epilepsy to guide personalized dosing.

## Contribution

The study identifies age and non-hepatic enzyme-inducing antiepileptic drugs as key factors influencing lacosamide serum concentrations in children.

## Key findings

- Older children (>12 years) had higher lacosamide doses and concentration-to-dose ratios compared to younger children.
- Concomitant non-hepatic enzyme-inducing AEDs increased lacosamide serum concentration and CDR.
- Body weight, weight-adjusted dose, and coadministration of non-hepatic enzyme-inducing AEDs were independent predictors of serum concentration.

## Abstract

To explore the influencing factors of lacosamide serum concentration in children with epilepsy, and to provide evidence-based guidance for individualized dosing strategies.

Clinical data of pediatric epilepsy patients treated with lacosamide from September 2021 to January 2025 were retrospectively analyzed. Participants were stratified by age into ≤6, 6–12, and >12 years groups. Non-parametric tests were employed to compare differences in daily dose, weight-adjusted daily dose, serum concentration, and concentration-to-dose ratio (CDR) across sex, age, and concomitant antiepileptic drugs (AEDs) groups. Multiple linear regression analysis was conducted to identify independent factors influencing serum concentration.

The study enrolled 438 patients (boys: 261, 59.59%; girls: 177, 40.41%), with age distribution as follows: ≤ 6 years (n = 85, 19.41%), 6–12 years (n = 294, 67.12%), and >12 years (n = 59, 13.47%). The > 12 years group exhibited significantly higher daily dose, weight-adjusted daily dose, and CDR compared to younger cohorts. Concomitant use of non-hepatic enzyme-inducing AEDs resulted in elevated serum concentration and CDR relative to lacosamide monotherapy. Regression analysis identified body weight, weight-adjusted daily dose, and coadministration of non-hepatic enzyme-inducing AEDs as independent predictors of serum concentration.

Age and concomitant non-hepatic enzyme-inducing AEDs therapies significantly influence lacosamide exposure, underscoring the necessity for age-based dynamic dose optimization and rigorous evaluation of polypharmacy regimens to achieve precision therapeutics.