Levetiracetam

1. Introduction

Levetiracetam is an antiepileptic drug (AED) used to treat epilepsy by modulating neuronal excitability. It is effective in managing focal and generalised seizures and is characterised by its rapid onset, minimal drug interactions, and favourable side-effect profile.

2. Indications

  • Approved Indications:
    • Focal seizures (with or without secondary generalisation) in adults and children ≥1 month old.
    • Generalised tonic-clonic seizures in patients ≥6 years old with idiopathic generalised epilepsy.
    • Myoclonic seizures in patients ≥12 years old with juvenile myoclonic epilepsy.
  • Off-Label Uses:
    • Seizure prophylaxis in traumatic brain injury.
    • Status epilepticus (as an adjunct).

3. Dosage

  • Adults and Adolescents (≥16 years):
    • Initial dose: 500 mg twice daily.
    • Maintenance dose: 500–1500 mg twice daily, depending on response.
    • Maximum dose: 3000 mg/day.
  • Children (1 month–15 years):
    • Dose based on weight: 10–60 mg/kg/day in two divided doses.
  • Elderly:
    • Start at the lower end of the dosing range, adjusting based on renal function.

4. Administration

  • Take orally, with or without food.
  • Swallow tablets whole with water; do not crush or chew.
  • The oral solution can be used for those who have difficulty swallowing tablets.

5. Forms Available

  • Tablets: 250 mg, 500 mg, 750 mg, 1000 mg.
  • Oral solution: 100 mg/mL.
  • Injection: 100 mg/mL (for IV administration).

6. Side Effects

6.1. Common Side Effects

  • Drowsiness or fatigue.
  • Dizziness.
  • Irritability or behavioural changes (especially in children).

6.2. Less Common Side Effects

  • Headache.
  • Nausea or vomiting.
  • Weakness or muscle pain.

6.3. Rare but Serious Side Effects

  • Severe mood changes, including depression or suicidal thoughts.
  • Hypersensitivity reactions (e.g., rash, angioedema).
  • Coordination issues (ataxia).

7. Warnings

  • Mood and Behaviour Changes: Levetiracetam may cause mood disturbances, irritability, and suicidal ideation. Monitor closely for these symptoms.
  • Hypersensitivity Reactions: Discontinue immediately if signs of an allergic reaction occur.
  • Withdrawal Seizures: Abrupt discontinuation may increase the risk of seizure recurrence. Taper off gradually under medical supervision.

8. Precautions

  • Use cautiously in:
    • Patients with a history of depression or psychiatric disorders.
    • Those with impaired renal function (dose adjustments required).
  • Avoid operating heavy machinery or driving until the effects of levetiracetam on alertness are known.

9. Interactions

  • Drug-Drug Interactions:
    • Minimal interactions with other antiepileptic drugs.
    • No significant interactions with oral contraceptives.
    • May enhance sedation when taken with CNS depressants (e.g., alcohol, benzodiazepines).
  • Drug-Food Interactions:
    • None significant.

10. Monitoring Parameters

  • Seizure frequency and severity.
  • Mood and behavioural changes (especially in children and adolescents).
  • Renal function (especially in elderly or renally impaired patients).

11. Use in Children

  • Approved for children ≥1 month old for focal seizures.
  • Monitor for behavioural changes or mood disturbances.

12. Use in Pregnancy

  • Category C: Use only if the benefits outweigh the risks. Some data suggest a low risk of teratogenicity, but caution is advised.
  • Encourage enrolment in pregnancy registries for AEDs to monitor outcomes.

13. Use in Elderly

  • Safe for use with dose adjustments based on renal function. Monitor for increased sedation and cognitive effects.

14. Use in Kidney Disease

  • Dose adjustment required in renal impairment based on creatinine clearance (CrCl):
    • CrCl 50–80 mL/min: Usual dose.
    • CrCl 30–50 mL/min: 250–750 mg twice daily.
    • CrCl <30 mL/min: 250–500 mg twice daily.
    • End-stage renal disease: Administer after dialysis.

15. Use in Liver Disease

  • No dose adjustments are necessary in mild to moderate liver impairment.
  • Use with caution in severe hepatic impairment, as data are limited.

16. Patient Counselling Points

  • Take levetiracetam as prescribed, and do not skip doses to avoid breakthrough seizures.
  • Report any mood changes, irritability, or suicidal thoughts to your doctor immediately.
  • Avoid alcohol, as it may worsen side effects such as dizziness or drowsiness.
  • Do not stop taking levetiracetam suddenly without consulting your doctor.
  • Ensure regular follow-up visits for monitoring seizure control and side effects.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
KeppraUCB Pharma$200–300 (30 tablets, 500 mg)
Generic LevetiracetamVarious manufacturers$15–50 (30 tablets, 500 mg)

18. FAQs (15 Questions)

  1. What is levetiracetam used for?
    It is used to treat focal seizures, generalised tonic-clonic seizures, and myoclonic seizures.
  2. How does levetiracetam work?
    It modulates neuronal activity by binding to synaptic vesicle protein 2A, stabilising brain activity.
  3. When should I take levetiracetam?
    Take it twice daily, at the same time each day, with or without food.
  4. Can levetiracetam cause side effects?
    Yes, common side effects include drowsiness, dizziness, and mood changes.
  5. Can levetiracetam be stopped suddenly?
    No, stopping abruptly can lead to withdrawal seizures. Consult your doctor before discontinuing.
  6. Is levetiracetam safe during pregnancy?
    It can be used if the benefits outweigh risks, but close monitoring is required.
  7. Does levetiracetam interact with other antiepileptic drugs?
    No significant interactions, making it a favourable choice for polytherapy.
  8. Can I drink alcohol while taking levetiracetam?
    Avoid alcohol, as it may worsen side effects like dizziness and sedation.
  9. Is levetiracetam safe for children?
    Yes, it is approved for use in children ≥1 month old.
  10. What should I do if I miss a dose of levetiracetam?
    Take it as soon as you remember, unless it’s close to the next dose. Do not double up.
  11. How long does levetiracetam take to work?
    It may take a few days to weeks to achieve optimal seizure control.
  12. Does levetiracetam cause weight gain?
    Weight gain is not a common side effect of levetiracetam.
  13. How should levetiracetam be stored?
    Store at room temperature, away from moisture and light.
  14. Can levetiracetam cause mood changes?
    Yes, mood changes such as irritability or depression can occur, especially in children.
  15. Is levetiracetam available as a generic?
    Yes, generic levetiracetam is widely available and more affordable.