Levetiracetam

Levetiracetam Introduction

Levetiracetam (Keppra) is an anti-epileptic medication that is used to treat certain types of seizures in adults and children. It is used as an adjunct therapy to treat partial onset seizures and primary generalized tonic-clonic seizures. It works by reducing the activity of the neurons that cause seizures.

Uses for Levetiracetam

Levetiracetam is used to treat partial onset seizures and secondarily generalized tonic-clonic seizures in adults and children four years of age and older. It can also be used in patients who are at risk of further seizures.

Brand Name	Levetiracetam
Type
Weight
Generic	Levetiracetam
Manufacturer
Available in	English বাংলা

Mechanism of Action

Levetiracetam works by binding to a specific receptor in the brain, known as the SV2A receptor. This binding action reduces the amount of glutamate, an excitatory neurotransmitter, and increases the amount of GABA, an inhibitory neurotransmitter. This action is believed to reduce the activity of neurons that cause seizures.

How Long Does It Take To Work?

The effects of levetiracetam can be seen within one to two weeks of starting the medication. Approximately 50-70% of patients will experience a reduction in seizure frequency within six weeks of starting the medication.

Absorption

Levetiracetam is quickly and completely absorbed from the gastrointestinal tract following oral administration.

Route of Elimination

Levetiracetam is primarily metabolized in the liver by enzymes to its active metabolites. Most of the drug is eliminated in the urine and some in the feces.

Dosage

Adults and adolescents from 16 years of age: The recommended starting dose is 250 mg twice daily which should be increased to an initial therapeutic dose of 500 mg twice daily after two weeks. The dose can be further increased by 250 mg twice daily every two weeks depending upon the clinical response. The maximum dose is 1500 mg twice daily.

Adults (≥18 years) and adolescents (12 to 17 years) weighing 50 kg or more: The initial therapeutic dose is 500 mg twice daily. This dose can be started on the first day of treatment. Depending upon the clinical response and tolerability, the daily dose can be increased up to 1,500 mg twice daily. Dose changes can be made in 500 mg twice daily increases or decrease every two to four weeks.

Pediatric population: The tablet formulation is not adapted for use in infants and children under the age of 6 years. Oral solution is the preferred formulation for use in this population. In addition, the available dose strengths of the tablets are not appropriate for initial treatment in children weighing less than 25 kg, for patients unable to swallow tablets or for the administration of doses below 250 mg. In all of the above cases, oral solution should be used.

• Monotherapy: The safety and efficacy of levetiracetam in children and adolescents below 16 years as monotherapy treatment have not been established.
• Add-on therapy: Oral solution is the preferred formulation for use in infants and children under the age of 6 years. For children 6 years and above, oral solution should be used for doses under 250 mg, for doses not in multiples of 250 mg when dosing recommendation is not achievable by taking multiple tablets and for patients unable to swallow tablets. The lowest effective dose should be used. The starting dose for a child or adolescent of 25 kg should be 250 mg twice daily with a maximum dose of 750 mg twice daily. Dosing for children 50 kg or greater is the same as in adults.
• Add-on therapy: For infants aged from 1 month to less than 6 months: The oral solution is the formulation to use in infants.

Dosage requirements for levetiracetam vary depending on the type and severity of the seizure disorder. In general, the recommended dosage for adults is 1000-3000 mg/day taken in two or three divided doses. For children ages four years and older, the dose is 10-50 mg/kg/day divided into two or three doses.

Administration

Levetiracetam is taken orally as a tablet, oral solution or IV solution.

Side Effects

Common side effects of levetiracetam include drowsiness, dizziness, asthenia, headache, vertigo, somnolence, fatigue, and irritability. Other more serious side effects can include psychosis, aggression, and ideation.

Toxicity

At recommended doses, levetiracetam is considered safe and well tolerated. At higher doses, there is potential for a decrease in plasma levels of folate and vitamin B12 and a decrease in red blood cell count (anemia). There is also potential for reversible increases in serum transaminase levels.

Precautions

Patients should be monitored for changes in behavior, including signs of depression or suicidal ideation. Patients should also be monitored for signs of kidney failure and monitored for drugs that interact with levetiracetam.

Interactions

Levetiracetam may interact with other medications and should not be taken with certain drugs, such as phenytoin, phenobarbital, rifampicin, and lamotrigine.

Disease Interaction

Levetiracetam can be used safely in patients with kidney or liver impairment. It can also be used in patients with depression or anxiety.

Drug Interaction

Levetiracetam can interact with other drugs including anticonvulsants, antidepressants and certain antibiotics.

Food Interactions

Levetiracetam can be taken with or without food. It is best taken with food to help reduce stomach upset.

Pregnancy Use

Levetiracetam is classified as Pregnancy Category C. The safety of levetiracetam in pregnancy has not been firmly established and it is not recommended for pregnant women, except if the potential benefit outweighs the potential risk.

Lactation Use

Levetiracetam is excreted in the milk of lactating mothers. It is not recommended for use in breastfeeding mothers.

Acute Overdose

No specific antidote is available for overdose with levetiracetam. Symptoms of overdose may include sedation, nausea, vomiting, and unsteadiness. Treatment should be supportive and symptomatic and adlibitum fluid should be incorporated.

Contraindication

Levetiracetam is contraindicated in patients with an allergy to levetiracetam or any of its components.

Use Directions

Levetiracetam should be taken as directed by your healthcare provider. The dosage requirements may vary depending on the type and severity of the seizure disorder.

Storage Condition

Levetiracetam should be stored at room temperature away from moisture and heat.

Volume of Distribution

The volume of distribution for levetiracetam is 0.5-1.0 L/kg.

Half Life

The half-life of levetiracetam is 6-8 hours.

Clearance

Levetiracetam is cleared by the kidney and the elimination half-life is unaffected by renal impairment. The renal clearance is 0.19-0.42 L/h.

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