Levetiracetam

Brands

DEA Class;  Rx

Common Brand Names; Keppra, Keppra XR, Spritam, Elepsia

  • SV2A Ligands

Oral and intravenous pyrrolidine derivative antiepileptic drug
Used for the treatment of certain types of partial, myoclonic, and generalized tonic-clonic seizures
Monitor for emerging or worsening suicidal thoughts/behavior and depression

Indicated for treatment of partial-onset seizures

For the adjunctive treatment of myoclonic seizures in those with juvenile myoclonic epilepsy.

Hypersensitivity

  • Asthenia (11-15%)
  • Headache (14-19%)
  • Infection (11-15%)
  • Increased blood pressure (17% in children < 4 years)
  • Somnolence (11-15%)
  • Drowsiness (2-23%)
  • Fatigue (10-11%)
  • Anorexia (3-13%)
  • Weakness (9-15%)
  • Nasopharyngitis (7-15%)
  • Cough (2-11%)
  • Viral infection (2%)
  • Asthma (2%)
  • Dizziness (5-9%)
  • Nervousness (2-10%)
  • Amnesia (2%)
  • Anxiety (2-3%)
  • Ataxia (3%)
  • Depression (2-5%)
  • Hostility (10%)
  • Paresthesia (2%)
  • Sinusitis (2%)
  • Diplopia (2%)
  • Amblyopia (2%)
  • Conjunctivitis (2-3%)
  • Albuminuria (4%)
  • Abnormal hepatic function tests
  • Dyskinesia
  • Eczema
  • Neutropenia
  • Decreased hematocrit
  • Leukopenia
  • Suicidal tendencies
  • Hepatitis
  • Pancreatitis
  • Bone marrow suppression
  • Epidermal necrolysis

Somnolence and asthenia occurred most frequently within first 4 weeks of treatment; patients should be monitored for signs and symptoms and advised not to drive or operate machinery until they have gained sufficient experience on levetiracetam to gauge whether it adversely affects ability to drive or operate machinery

As with most antiepileptic drugs, drug should generally be withdrawn gradually because of risk of increased seizure frequency and status epilepticus; if withdrawal needed because of serious adverse reaction, rapid discontinuation can be considered

Psychiatric reactions: 13.3% of adults and 37.6% of children treated with levetiracetam reported nonpsychotic behavioral symptoms (eg, aggression, agitation, anger, anxiety, apathy, depersonalization, lability, hostility, hyperkinesis, irritability, nervousness, neurosis, and personality disorder) compared to 6.2% and 18.6% of adult and pediatric placebo patients respectively; dose reduction or discontinuation may be required

Monitor patients for behavioral abnormalities including psychotic symptoms, suicidal ideation, irritability, aggressive behavior, and for new or worsening depression, suicidal thoughts/behavior, and/or unusual changes in mood or behavior

Serious dermatological reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) reported; median time of onset is reported to be 14-17 days; if signs or symptoms suggest SJS/TEN, use of this drug should not be resumed and alternative therapy should be considered

Drug rash with eosinophilia and systemic syndrome (DRESS) reported

May impair ability to operate heavy machinery

There are no adequate and well-controlled studies in pregnant women; prolonged experience in pregnant women has not identified a drug-associated risk of major birth defects or miscarriage, based on published literature, which includes data from pregnancy registries, and reflects experience over two decades

Drug is excreted in human milk; there are no data on effects of drug on breastfed infant, or on milk production

Unknown if distributed in human breast milk

Adults

3,000 mg/day PO or IV.

Geriatric

3,000 mg/day PO or IV.

Adolescents

16 to 17 years: 3,000 mg/day PO or IV; guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV (Max: 4,500 mg).
13 to 15 years: 60 mg/kg/day PO or IV (Max: 3,000 mg/day); guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV (Max: 4,500 mg).

Children

4 to 12 years weighing more than 40 kg: 60 mg/kg/day PO (oral solution) or IV (Max: 3,000 mg/day); 3,000 mg/day for immediate-release and fast-melting tablets. Guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV (Max: 4,500 mg).
4 to 12 years weighing 20 to 40 kg: 60 mg/kg/day PO (oral solution) or IV; 1,500 mg/day for immediate-release and fast-melting tablets. Guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV.
1 to 4 years: 50 mg/kg/day PO or IV; guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV.

Infants

6 to 11 months: 50 mg/kg/day PO or IV; guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV.
1 to 5 months: 42 mg/kg/day PO or IV; guidelines for convulsive status epilepticus propose a load of 60 mg/kg IV.

Neonates

Safety and efficacy have not been established; doses of up to 60 mg/kg/day PO and 80 mg/kg/day IV have been have been reported for the off-label treatment of seizures.

Levetiracetam

tablet, immediate-release (Keppra, generic)

  • 250mg
  • 500mg
  • 750mg
  • 1000mg

3-D tablet, immediate-release (Spritam)

  • 250mg
  • 500mg
  • 750mg
  • 1000mg

tablet, extended-release

  • 500mg (Keppra XR)
  • 750mg (Keppra XR)
  • 1000mg (Elepsia XR)
  • 1500mg (Elepsia XR)

oral solution (Keppra, generic)

  • 100mg/mL

injectable solution

  • 5mg/mL
  • 10mg/mL
  • 15mg/mL
  • 100mg/mL
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