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Levetiracetam

Brands and Forms

  • Keppra
    • immediate-release tablet: 250mg, 500mg, 750mg.
    • oral solution: 100mg/ml
    • injection solution: 100mg/ml
  • Keppra XR
    • extended-release tablet: 500mg

Uses of Levetiracetam

In psychiatry, Levetiracetam can be used in the treatment of Manic and Mixed Episodes in Bipolar Disorder, and also for Social Phobia.

In general medicine, Levetiracetam is used for treating seizure disorders and neuropathic pain.

How Levetiracetam Works

Levetiracetam is an anticonvulsant. It blocks the activity of inhibitors of GABA and glycine-gated channels, and partially blocks N-type calcium channels in neurons.

Cautions when Using Levetiracetam

Standard considerations.

Dosing of Levetiracetam

The initial dose of Levetiracetam is 1000mg/day. The dose can be increased by 1000mg/day every 2 weeks to a maximum dose of 3000mg/day.

In children and adolescents ages 4-16, intial dose is 20 mg/kg/day. The dose may be increased by 20 mg/kg/day every 2 weeks to a maximum of 60mg/kg/day.

When the immediate-release tablet is used, it is given twice a day. The extended-release tablet is given once a day in the morning.

When wanting to stop this medication, the dose should be decreased gradually over a period of a few weeks.

Onset of action

Therapeutic effects for psychiatric conditions are usually not expected before 2 weeks.

Kidney impairment

For mild renal function impairment (CrCl 50 to 80 mL/min), aim for a dose range of 1000-2000mg/day. For moderate impairment (CrCl 30 to 50 mL/min), aim for a dose range of 500-1500mg/day. For severe impairment (CrCl less than 30 mL/min), do not exceed 1000mg/day.

For patients on dialysis, give 500-1000mg of the immediate-release tablet every 24 hours. Following dialysis, a 250-500 mg supplemental dose is recommended.

Liver impairment

No dose adjustment is required.

Side-effects of Levetiracetam

Below is a list of most of the reported side-effects of Levetiracetam. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Central Nervous System: somnolence; muscle weakness; headache; fatigue; dizziness; virtigo; unsteadiness; seizures; memory difficulties; confusion; increased or decreased sleep; increased reflexes; paresthesia.

Dermatologic: Itchiness; skin discoloration; vesiculobullous rash; hair loss.

Endocrine/Metabolic: weight loss.

Eyes, Ears, Nose and Throat: nasopharyngitis; rhinitis; pharyngitis; conjunctivitis; amblyopia; diplopia; ear pain.

Gastrointestinal: vomiting; loss of appetite; diarrhea; nausea; gastroenteritis; constipation; pancreatitis (very rare); liver impairment (very rare).

Genitourinary: albuminuria.

Hematologic: bruising; blood dyscrasias (very rare).

Muskuloskeletal: neck pains. .

Psychiatric: irritability; anxiety; personality changes; agitation; emotional lability; depressed mood; suicidal behaviors.

Respiratory: cough; reactive airway disease; sinusitis.

Common side-effects of Levetiracetam

Somnolence, muscle weakness, headache, irritability, fatigue, anxiety, dizziness, vomiting, loss of appetite, diarrhea, cough.

Rare but serious side-effects of note of Levetiracetam

Suicidal behaviors.

Levetiracetam overdose

Aggression, agitation, depressed level of consciousness, drowsiness, respiratory depression, somnolence, coma.

Levetiracetam and pregnancy

Category C: some animal studies show adverse effects at very high doses, but no controlled human studies have been done; should only be used in pregnancy if clearly needed and if benefits outweigh potential risks.

Medical Monitoring for Levetiracetam

None for healthy individuals.

Drug Interactions with Levetiracetam

No significant drug interactions.