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 (as of 1st January 2021) is:

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.

Resources

 

 

 

Side effects

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.

Dosage

  • 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.

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.