Lacosamide in Palliative Care: A Case Series

Neuropathic pain is a common and often challenging symptom in palliative care.Lacosamide has recently emerged as an unlicensed option for managing refractory neuropathic pain.This case series explores the use of lacosamide in four patients who were admitted to a hospice for symptom management.Whilst a potential analgesic benefit was observed in some cases, treatment was limited by adverse effects possibly associated with lacosamide, requiring dose reduction or discontinuation.These cases support the recommendation that lacosamide should be used as a second-line adjuvant for refractory neuropathic pain with gradual dose titration.Furthermore, they highlight the challenges in assessing lacosamide tolerability in palliative care, as there can often be an overlap between lacosamide-related adverse effects and symptoms of underlying pathology or alternative medication adverse effects.This can contribute to diagnostic overshadowing in clinical practice, delaying timely diagnosis and management of lacosamide-related adverse effects.