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Levetiracetam

Classification

Antiepileptic

Indications

CCP: Generalized tonic-clonic seizure, partial seizures, myoclonic epilepsy

Contraindications

Hypersensitivity
Avoid abrupt withdrawal.

Caution

Pregnancy
CrCl < 80
Psychiatric disorder

Adult dosages

CCP: Partial and generalized seizures

500 mg IV q 12 hours
Dosing adjustments need to be made for renal impairment.

CCP: Status epilepticus

40-60 mg/kg IV single dose over 5-15 minutes. (Max dose 4.5 g)

Pediatric Considerations And Dosing

CCP: All indications

< 6 years: efficacy not established.
6-16 years: 10 mg/kg PO or IV q 12 hours (Max dose 3g)
> 16 years: 500 mg PO q 12 hours

Mechanism Of Action

Precise mechanism is unknown. Anticonvulsant activity is thought to occur because of inhibition of voltage-dependant N-type calcium channels. Keppra may also bind to synaptic proteins that modulate neurotransmitter release. Displacement of negative modulators may facilitate a GABA inhibitory response.

Pharmacokinetics

Peak plasma time: 4 hours oral, 5-30 minutes IV

Half-life: 6-8 hours

Adverse Effects

Depression
Hostility
Psychosis
Suicidal ideation
Leukopenia
Neutropenia
Pancytopenia
Agranulocytosis
Thrombocytopenia
Anaphylaxis
Angioedema
SJS
Toxic epidermal necrosis
Erythema multiforme
Hyponatremia
Acute renal failure
Rhabdomyolysis
Withdrawal seizure if abrupt D/C
Vomiting
Hypertension
Asthenia
Nasopharyngitis

Warning And Precautions

Monitor Cr at baseline and adjust dosing, use cautiously.
Monitor for somnolence.
Withdraw slowly as abrupt D/C may induce seizure activity.
Monitor for behavioral changes and suicidal ideation.
Monitor blood work especially WBC, and RBC counts.
Monitor dermatological reactions such as TEN’s and SJS.

Drug Interactions

Deferiprone
Metoclopramide
Acalabrutinib
Brexanolone
Brivaracetam
Deuterabenazine
Esketamine
Lasmiditan
Lemborexant
Lurasidone
Midazolam
Orlistat
Sevelamer
Stripentol