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Yes, concomitant medications can alter safe lacosamide dosing. Lacosamide is an antiepileptic drug used to treat partial-onset seizures. Like many other medications, its dosage can be affected by other substances in a patient's system.

One way concomitant medications can interact with lacosamide is by affecting its metabolism. Lacosamide is primarily metabolized by CYP3A4 and, to a lesser extent, by CYP2C9 and CYP2C19 [1]. Therefore, any medication that induces or inhibits these cytochrome P450 enzymes can impact lacosamide metabolism and, consequently, its serum concentration.

For instance, strong CYP3A4 inducers, such as rifampin, carbamazepine, and phenytoin, can decrease lacosamide exposure, potentially reducing its effectiveness [1]. On the other hand, strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, and clarithromycin, can increase lacosamide exposure, potentially leading to adverse effects [1].

Moreover, lacosamide is a weak inhibitor of P-glycoprotein (P-gp) [1]. Therefore, concomitant medications that are P-gp substrates may have increased serum concentrations when administered with lacosamide.

It is important to note that the effects of concomitant medications on lacosamide dosing can vary depending on several factors, such as the specific medication, dosage, route of administration, and individual patient characteristics. Therefore, healthcare professionals should consider these factors when prescribing lacosamide and monitor patients closely for efficacy and safety [1].

In summary, concomitant medications can alter safe lacosamide dosing by affecting its metabolism and transport. Healthcare professionals should consider these interactions when prescribing lacosamide and monitor patients closely for efficacy and safety.

Sources:
[1] Lacosamide [PDF]. In: FDA.gov. U.S. Food and Drug Administration; 2014. Accessed: April 11, 2023. [https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022437s000lbl.pdf](https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022437s000lbl.pdf)
[2] DrugPatentWatch.com. Lacosamide - Drug Patent Expirations. Accessed: April 11, 2023. [https://www.drugpatentwatch.com/drugs/lacosamide](https://www.drugpatentwatch.com/drugs/lacosamide)