Generic
Levetiracetam
54 brands available in the market
At a glance
Levetiracetam is an anti-epileptic medicine used to prevent seizures (fits) in epilepsy. It suppresses abnormal electrical activity in the brain by attaching to specific sites (SV2A) on nerve cell surfaces.
Description
The precise mechanism of Levetiracetam's antiepileptic effect is unknown. It protects against secondarily generalized activity from focal seizures induced by pilocarpine and kainic acid. In vitro and in vivo recordings have shown that Levetiracetam inhibits epileptiform burst firing without affecting normal neuronal excitability, suggesting it selectively prevents hypersynchronization of epileptiform burst firing and propagation of seizure activity.
Indications
- Partial-onset seizures (with or without secondary generalization) - monotherapy (16 years+) and adjunctive therapy (1 month+)
- Myoclonic seizures - Juvenile Myoclonic Epilepsy (12 years+) adjunctive therapy
- Primary generalized tonic-clonic seizures - Idiopathic Generalized Epilepsy (12 years+) adjunctive therapy
Therapeutic class
Adjunct Anti-epileptic
Pharmacological class
Anticonvulsant
Pharmacology
Levetiracetam exerts its antiepileptic effect by inhibiting epileptiform burst firing and preventing propagation of seizure activity.
Mechanism of action
Suppresses abnormal electrical activity by attaching to SV2A sites on nerve cells.
Dosage
Adult (Monotherapy): 250 mg twice daily start, increase to 500 mg twice daily after 2 weeks; may increase by 250 mg twice daily every 2 weeks; max 1,500 mg twice daily
Adult (Adjunctive): 500 mg twice daily start; adjust by 500 mg twice daily every 2-4 weeks; max 1,500 mg twice daily
Children (1-6 months): 20 mg/kg/day start; increase by 20 mg/kg every 2 weeks; max 60 mg/kg/day
Renal Impairment: CrCl <30: 250-500 mg twice daily; 30-49: 250-750 mg twice daily; 50-79: 500-1,000 mg twice daily
Administration
- Swallow tablets whole with water; do not chew, crush or break
- May be taken with or without food, but at a fixed time is preferable
- Daily dose is administered in two equally divided doses
Missed dose
If you miss a dose, take it as soon as possible. If it's almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Side effects
Common Side Effects (Adults):
- Somnolence
- Asthenia
- Infection
- Dizziness
Pediatric: Fatigue, aggression, nasal congestion, decreased appetite, irritability
Other: Headache, behavioral changes, aggressive behavior, anxiety
Precautions & warnings
- Avoid driving or activities requiring concentration (may cause drowsiness or dizziness)
- Monitor for suicidal thoughts or behavior
- Monitor blood cell counts (neutropenia, agranulocytosis)
- Dose adjustment needed in renal impairment
- In severe hepatic impairment, reduce dose by 50% if CrCl <60
Contraindications
- Hypersensitivity to Levetiracetam or other pyrrolidone derivatives
Drug interactions
- Enzyme-inducing antiepileptic drugs
- Probenecid inhibits renal clearance of primary metabolite
- Methotrexate: Decreases methotrexate clearance (increases toxic levels)
- Macrogol (osmotic laxative): Decreases levetiracetam efficacy (avoid 1 hour before/after)
Food interactions
Alcohol consumption with Levetiracetam is unsafe.
Use in pregnancy
Use in Pregnancy: Levetiracetam may be unsafe during pregnancy; animal studies have shown harmful effects on the fetus. Not recommended unless clinically necessary.
Use in lactation
Use in Lactation: Levetiracetam is excreted in human breast milk; breastfeeding is not recommended. If needed, weigh benefit/risk. Monitor baby for sleepiness and weight gain.
Pediatric use
Tablet formulation not suitable for children under 6 years; oral solution is preferred.
Geriatric use
Elderly (65+): Dose adjustment based on renal function.
Renal / hepatic impairment
Renal Impairment: Daily dose must be individualized based on renal function; CrCl-based dose adjustment needed.
Hepatic Impairment: Mild-moderate: no dose adjustment; severe: reduce dose by 50% if CrCl <60.
Overdose effects
Overdose symptoms: somnolence, agitation, aggression, depressed consciousness, respiratory depression, and coma. Gastric lavage or induced emesis; hemodialysis is effective (60% elimination).
Storage conditions
Store below 25°C in a cool and dry place, protected from light.
Chemical structure
Levetiracetam