- Levetiracetam has a broad efficacy profile and can be useful in multiple seizure types (focal, generalised, myoclonic).
- Overall, side-effect profile is good, with few drug interactions.
- Its PBS indication is for add-on therapy rather than first-line therapy (e.g. focal seizures failing other drugs).
- It has been used (off-label) in neonates and young children.
Notable side effects
- Drowsiness or somnolence.
- Disturbed behaviour, agitation or emotional lability, or mood changes can occur. Aggressiveness may be as frequent as 1 in 5.
- Drug withdrawal must be strongly considered if suicidal ideation occurs.
- Rash is uncommon.
- Rarely, a neutropenia, thrombocytopenia or liver dysfunction may occur.
- All anticonvulsants are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
For a complete list of adverse effects, appropriate formularies should be consulted.
- The initiation and escalation dose depends upon age, weight, syndrome, seizure frequency and intensity, and side effect profile.
- Unfortunately, a one dose regime does not fit all.
- A Paediatric Neurologist should be consulted if there is uncertainty.
- Using intravenous formulation, levetiracetam can be used in emergency situations, e.g. status epilepsy. Similar dosage is used for intravenous administration if patient is already on oral levetiracetam.
Commonly used regime
- Target dose 20-40mg/kg/day in two divided doses. Higher doses may be used (for example up to 60mg/kg).
- Start 10-20mg/kg/day in two divided doses, increasing each 2 weeks by 10mg/kg/day.
- Dosages per kilogram can only be used in children of weight approximately up to 30-40kgs. Consult appropriate formularies for higher weights and in the adult range.
- These dosages are only a guideline and appropriate formularies should be consulted as needed.
- Oral solution 100mg/ml or Tablet 250mg, 500mg, 1,000mg.
- There is an intravenous form.
- No drug level monitoring is currently available.
Interactions | Precautions
There are minimal drug interactions.