Drugs that inhibit voltage-dependent sodium channels are commonly used to treat epilepsy. Old and novel antiepileptic drugs are used either as monotherapy or in combination to control epilepsy. For a long time, carbamazepine has been used as the first choice for the treatment of simple and complex partial seizures. In the USA, lacosamide was approved in October 2008 as an adjunctive treatment for partial-onset seizures. We describe the effect of two sodium channel blockers on the heart of a patient with epilepsy.
Learning points: Approximately 30% of patients with epilepsy require combination therapy with antiepileptic drugs for seizure reduction.Lacosamide and carbamazepine are both sodium channel blockers but exert their effects through different mechanisms.Electrocardiogram monitoring is necessary when lacosamide and carbamazepine are used together as this combination may predispose to seizures, conduction abnormalities and dysrhythmia.
