levetiracetam, Keppra, Keppra XR
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: levetiracetam
BRAND NAME: Keppra, Keppra XR
DRUG CLASS AND MECHANISM: Levetiracetam is an antiseizure (antiepileptic) drug. Its mechanism of action is unknown, but it inhibits the spread of seizure activity in the brain. In studies, addition of levetiracetam to other antiseizure drugs reduced the frequency of seizures more than placebo. The FDA approved levetiracetam in November 1999.
PREPARATIONS: Tablets (immediate release): 250, 500, 750 and 1000 mg. Tablets (extended release): 500and 750 mg. Oral solution: 100 mg/ml. Injection solution: 100 mg/ml.
STORAGE: Levetiracetam should be stored at 25 C (77 F). Brief storage at 15-30 C (59-86 F) is acceptable.
PRESCRIBED FOR: Levetiracetam is used in combination with other antiseizure medications to treat myoclonic, partial onset, or tonic clonic seizures in children and adults.
DOSING: The recommended daily dose of levetiracetam in adults is 3000 mg. Therapy is initiated with 1000 mg daily (500 mg twice daily) and increased by 1000 mg/day every two weeks up to the maximum recommended dose of 3000 mg/day. Immediate release tablets, oral solution, and intravenous solutions are administered twice daily, and extended release tablets are administered once daily. The recommended daily dose for children is 60 mg/kg (30 mg/kg twice daily). Therapy is initiated with 20 mg/kg (10 mg/kg twice daily) and increased by 20 mg/kg every two weeks until the recommended daily dose of 60 mg/kg is reached.
DRUG INTERACTIONS: Probenecid (Benemid) reduces the elimination of levetiracetam by the kidneys, potentially doubling the concentration of levetiracetam in the body. This could lead to side effects from probenecid.
PREGNANCY: Levetiracetam has not been adequately studied in pregnant women. Levetiracetam is used during pregnancy only if the benefit justifies the potential risk to the fetus.
NURSING MOTHERS: Levetiracetam is excreted in breast milk. To avoid potential serious side effects in infants who are breastfeeding mothers should consider not breast-feeding while taking levetiracetam.
SIDE EFFECTS: Common side effects associated with levetiracetam include headache, sleepiness, weakness, dizziness, and infection. Difficulty walking or moving, hostility, irritability, mood swings, anxiety, hallucinations, and delusions also have been associated with levetiracetam. A small number of patients may experience a decrease in red or white blood cell counts. Like other antiseizure medications, levetiracetam should not be discontinued suddenly because of the risk of increased seizure activity.
Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.
Reference: FDA Prescribing Information
Last Editorial Review: 12/10/2008
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