Levetiracetam

GENERIC NAME: levetiracetam

DRUG CLASS AND MECHANISM
Levetiracetam is an antiseizure (antiepileptic) drug. Its mechanism of action is unknown, but it inhibits the spread of seizure activity in the brain. In studies, addition of levetiracetam to other antiseizure drugs reduced the frequency of seizures more than placebo. The FDA approved levetiracetam in November 1999.

GENERIC AVAILABLE: Yes

PRESCRIPTION: Yes

PREPARATIONS
Tablets (immediate release): 250, 500, 750 and 1000 mg. Tablets (extended release): 500 and 750 mg. Oral solution: 100 mg/ml. Injection solution: 100 mg/ml.

STORAGE
Levetiracetam should be stored at 25 C (77 F). Brief storage at 15-30 C (59-86 F) is acceptable.

PRESCRIBED FOR
Levetiracetam is used in combination with other antiseizure medications to treat myoclonic, partial onset, or tonic clonic seizures in children and adults.

DOSING
The recommended daily dose of levetiracetam in adults is 3000 mg. Therapy is initiated with 1000 mg daily (500 mg twice daily) and increased by 1000 mg/day every two weeks up to the maximum recommended dose of 3000 mg/day. Immediate release tablets, oral solution, and intravenous solutions are administered twice daily, and extended release tablets are administered once daily. The recommended daily dose for children is 60 mg/kg (30 mg/kg twice daily). Therapy is initiated with 20 mg/kg (10 mg/kg twice daily) and increased by 20 mg/kg every two weeks until the recommended daily dose of 60 mg/kg is reached.

DRUG INTERACTIONS
Probenecid (Benemid) reduces the elimination of levetiracetam by the kidneys, potentially doubling the concentration of levetiracetam in the body. This could lead to side effects from probenecid.

PREGNANCY
Levetiracetam has not been adequately studied in pregnant women. Levetiracetam is used during pregnancy only if the benefit justifies the potential risk to the fetus.

NURSING MOTHERS
Levetiracetam is excreted in breast milk. To avoid potential serious side effects in infants who are breastfeeding mothers should consider not breast-feeding while taking levetiracetam.

SIDE EFFECTS
Common side effects associated with levetiracetam include headache, sleepiness, weakness, dizziness, and infection. Difficulty walking or moving, hostility, irritability, mood swings, anxiety, hallucinations, and delusions also have been associated with levetiracetam. A small number of patients may experience a decrease in red or white blood cell counts. Like other antiseizure medications, levetiracetam should not be discontinued suddenly because of the risk of increased seizure activity.

Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

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