Levetiracetam

Usage

Levetiracetam has a broad efficacy profile and can be useful in multiple seizure types (focal, generalised, myoclonic).

Overall, side-effect profile is good, with minimal drug interactions.

 

PBS indication is:

Partial epileptic seizures

Clinical criteria: 

  • The condition must have failed to be controlled satisfactorily by other anti-epileptic drugs; OR
  • Patient must be a woman of childbearing potential, 

AND

  • The treatment must not be given concomitantly with brivaracetam, except for cross titration.

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Side effects

Possible 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.

Dosage

  • The below initiation and escalation doses are only a guide and need to be individualised based on patient (age, weight, co-morbidities), disease (seizure type, frequency, duration) and medication (metabolism, interactions, side-effect profile) characteristics.

 

  • Situations that require more careful consideration include children with higher weights, polytherapy, or multiple co-morbidities. Consultation with appropriate formularies or a paediatric neurologist may be required in specific circumstances.

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.
  • Recommended maximum adult dosage: 1.5 grams bd.
  • Dosages per kilogram can only be used up to weights of 30-40kgs.

Using intravenous formulation, levetiracetam can be used in emergency situations, e.g. status epilepsy. A similar dosage is used for intravenous administration if the patient is already on oral levetiracetam.

Preparations

  • Oral solution 100mg/ml or Tablet 250mg, 500mg, 1,000mg.
  • There is an intravenous form.

Monitoring

  • No drug level monitoring is currently available.

Interactions | Precautions

There are minimal drug interactions.

 

Information last reviewed: 24/04/2023.