Class: Anticonvulsant
Dosage Forms. Tablet: 250 mg, 500 mg, 750 mg, 1000 mg; Tablet (Extended Release): 500 mg, 750 mg; Oral Solution: 100 mg/mL
Common FDA Label Indication, Dosing, and Titration.
1. Myoclonic seizure, adjunct: Adults and Children 12 y and older: Initial, 500 mg po bid, target dose 3000 mg/d
2. Partial seizure, adjunct: Adults and Children 16 y and older (immediate release): Initial, 500 mg po bid, max 3000 mg/d; (extended release): Initial, 1000 mg po qd, max 3000 mg/d; Children 4-15 y (immediate release): Initial, 10 mg/kg po bid, max 60 mg/kg/d
3. Tonic-clonic seizure, primary generalized; adjunct: Adults and Children 16 y and older: Initial, 500 mg po bid, target dose 3000 mg/d; Children 6-15 y: Initial, 10 mg/kg po bid, target dose of 60 mg/kg/d
Off-Label Uses.
1. Bipolar disorder: 500 mg po bid
MOA. Levetiracetam is a pyrollidine derivative that is structurally unrelated to other antiepileptic drugs. Its mechanism of action is unclear and does not relate to any known mechanisms of neuronal excitation or inhibition. The action of levetiracetam in animal models of seizures and epilepsy is unique from other antiepileptic drugs.
Drug Characteristics: Levetiracetam
Medication Safety Issues: Levetiracetam
Drug Interactions: Levetiracetam
Adverse Reactions: Levetiracetam
Efficacy Monitoring Parameters. Reduction in the frequency and severity of seizures.
Toxicity Monitoring Parameters. Emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior, WBC, LFTs.
Key Patient Counseling Points. Instruct patient to swallow extended-release tablet whole; do not chew, break, or crush. Avoid activities requiring mental alertness or coordination until drug effects are realized. Report mood swings, agitation, hostile behavior, suicidal ideation, or unusual changes in behavior. Avoid sudden discontinuation of drug, may increase seizure activity.
Clinical Pearls. Safety and efficacy of tablets and solution not established in children <4 y of age. Safety and efficacy of extended-release tablet not established in children <16 y of age. Patients weighing ≤20 kg should be dosed with the oral solution. Data suggest an increased risk of suicidal behavior or ideation may exist in patients receiving therapy with antiepileptic drugs (AEDs). Pregnancy: up to a 50% dose increase during 3rd trimester with subsequent dose reduction after delivery may be necessary. Do not stop abruptly, increased risk of seizures. Dispense with medication safety guideline.