Pharmacological Incongruity of Lacosamide in the Management of Delirium Complicated by Ileus

Delirium involves neurotransmitter imbalances and disrupted neural networks. Although lacosamide may theoretically treat delirium by reducing neuronal hyperexcitability via sodium channel modulation, clinical evidence is lacking. Sodium channels in the enteric nervous system mean lacosamide can cause gastrointestinal dysmotility independent of anticholinergic pathways. Given these risks and potential disruptions to the gut-brain axis, off-label use requires extreme caution and rigorous monitoring.