Levetiracetam

Levetiracetam Brand Names

ELEPSIA XR | Keppra | Keppra XR | Roweepra | Spritam

What is Levetiracetam

Levetiracetam is a pyrrolidine derivative anticonvulsant used for the treatment of a variety of seizures types (partial onset, primary generalized tonic-clonic, myoclonic).

Guidelines recommend levetiracetam as a reasonable second-therapy option for convulsive status epilepticus (after a benzodiazepine).

Interactions with concomitantly administered antiepileptic drugs are minimal, and it has minimal adverse effects.

Both the oral solution and the IV formulation are FDA-approved for the treatment of partial seizures in patients as young as 1 month of age, the adjunctive treatment of myoclonic seizures in patients as young as 12 years with juvenile myoclonic epilepsy, and the adjunctive treatment of primary generalized tonic-clonic seizures in patients as young as 6 years with idiopathic generalized epilepsy; fixed-dose immediate-release tablets are labeled for patients weighing at least 20 kg.

The extended-release tablets are approved for the treatment of partial seizures in patients as young as 12 years.

Antiepileptic drugs (AEDs) such as levetiracetam increase the risk of suicidal ideation and behavior; monitor all patients receiving levetiracetam for emerging or worsening suicidal thoughts/behavior or depression.

Indications

  1. acute repetitive seizures
  2. myoclonic seizures
  3. partial seizures
  4. seizure prophylaxis
  5. status epilepticus
  6. tonic-clonic seizures

For the treatment of partial seizures

Side Effects

  1. abdominal pain
  2. acute generalized exanthematous pustulosis (AGEP)
  3. agitation
  4. agranulocytosis
  5. alopecia
  6. amnesia
  7. anaphylactic shock
  8. anaphylactoid reactions
  9. anemia
  10. angioedema
  11. anorexia
  12. anxiety
  13. arthralgia
  14. asthenia
  15. ataxia
  16. choreoathetosis
  17. confusion
  18. conjunctivitis
  19. constipation
  20. cough
  21. dehydration
  22. depression
  23. diarrhea
  24. diplopia
  25. dizziness
  26. drowsiness
  27. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  28. dyskinesia
  29. ecchymosis
  30. elevated hepatic enzymes
  31. emotional lability
  32. eosinophilia
  33. erythema multiforme
  34. fatigue
  35. hallucinations
  36. headache
  37. hepatic failure
  38. hepatitis
  39. hostility
  40. hyperkinesis
  41. hyperreflexia
  42. hypertension
  43. hyponatremia
  44. infection
  45. influenza
  46. insomnia
  47. irritability
  48. lethargy
  49. leukopenia
  50. musculoskeletal pain
  51. myasthenia
  52. nasal congestion
  53. nausea
  54. neutropenia
  55. otalgia
  56. pancreatitis
  57. pancytopenia
  58. paranoia
  59. paresthesias
  60. pharyngitis
  61. pneumonitis
  62. proteinuria
  63. pruritus
  64. psychosis
  65. rash
  66. rhabdomyolysis
  67. rhinitis
  68. seizures
  69. sinusitis
  70. Stevens-Johnson syndrome
  71. suicidal ideation
  72. thrombocytopenia
  73. toxic epidermal necrolysis
  74. urticaria
  75. vertigo
  76. vomiting
  77. weight loss

Monitoring Parameters

  • serum creatinine/BUN

Contraindications

  • abrupt discontinuation
  • breast-feeding
  • children
  • depression
  • dialysis
  • driving or operating machinery
  • geriatric
  • infants
  • neonates
  • pregnancy
  • psychosis
  • renal disease
  • renal failure
  • renal impairment
  • schizophrenia
  • suicidal ideation

Interactions

  • Alprazolam
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amphetamines
  • Azelastine; Fluticasone
  • Beclomethasone
  • Betamethasone
  • Budesonide
  • Budesonide; Formoterol
  • Bupropion
  • Bupropion; Naltrexone
  • Carbamazepine
  • Chlorpromazine
  • Ciclesonide
  • Clomipramine
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Colchicine; Probenecid
  • Colesevelam
  • Corticosteroids
  • Cortisone
  • Deflazacort
  • Desipramine
  • Dexamethasone
  • Dextromethorphan; Promethazine
  • Doxepin
  • Fludrocortisone
  • Flunisolide
  • Fluphenazine
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Hydrocortisone
  • Hydroxychloroquine
  • Imipramine
  • Isocarboxazid
  • Lithium
  • Maprotiline
  • Mefloquine
  • Meperidine; Promethazine
  • Mesoridazine
  • Methylprednisolone
  • Molindone
  • Mometasone
  • Monoamine oxidase inhibitors
  • Nortriptyline
  • Pemoline
  • Perphenazine
  • Perphenazine; Amitriptyline
  • Phenelzine
  • Phenothiazines
  • Phentermine; Topiramate
  • Phenylephrine; Promethazine
  • Prednisolone
  • Prednisone
  • Probenecid
  • Prochlorperazine
  • Promethazine
  • Protriptyline
  • Selegiline
  • Thiethylperazine
  • Thioridazine
  • Tolvaptan
  • Topiramate
  • Tranylcypromine
  • Triamcinolone
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
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