Overview

• Generic Name: Levetiracetam
• Brand Names: Keppra, Spritam, Elepsia, Roweepra
• Drug Class: Antiepileptic drug (AED)

Chemical Information

• Chemical Formula: C8H14N2O2
• Molecular Weight: 170.21 g/mol

Indications

• Epilepsy:
  • Partial-onset seizures (with or without secondary generalization)
  • Myoclonic seizures in patients with juvenile myoclonic epilepsy
  • Primary generalized tonic-clonic seizures in patients with idiopathic generalized epilepsy

Mechanism of Action

• Unknown Precise Mechanism: Levetiracetam's exact mechanism is not fully understood.
• Binding to SV2A: It is believed to modulate synaptic vesicle protein 2A (SV2A), which is involved in the release of neurotransmitters.
• Inhibition of N-type calcium channels: May inhibit these channels, reducing neurotransmitter release.

Pharmacokinetics

• Absorption: Rapid and nearly complete oral absorption.
• Bioavailability: Nearly 100%
• Peak Plasma Time: 1.3 hours after oral administration
• Distribution: Widely distributed throughout the body.
• Protein Binding: Less than 10%
• Metabolism: Minimal hepatic metabolism
• Elimination Half-life: Approximately 6-8 hours
• Excretion: Primarily excreted unchanged in urine.

Dosage Forms

• Tablets: Immediate-release and extended-release
• Oral Solution: 100 mg/mL
• Intravenous Solution: For patients who cannot take oral medications

Dosage

• Adults:
  • Initial dose: 500 mg twice daily.
  • Maintenance dose: Can be increased to 1500 mg twice daily, based on response and tolerability.
• Children:
  • Dosing varies based on age and weight.
  • Typically starts at 10 mg/kg twice daily, with adjustments based on clinical response.

Side Effects

• Common: Drowsiness, dizziness, fatigue, headache, irritability.
• Serious: Behavioral changes (aggression, agitation), suicidal thoughts, severe allergic reactions (rash, itching, swelling).

Contraindications

• Hypersensitivity: Known hypersensitivity to levetiracetam or any of its components.

Drug Interactions

• Minimal Drug Interactions: Levetiracetam has a low potential for drug interactions due to its minimal hepatic metabolism.
• CNS Depressants: Concurrent use with other CNS depressants may enhance central nervous system effects.

Monitoring

• Seizure Control: Regular monitoring of seizure frequency and severity.
• Behavioral Changes: Monitor for signs of mood changes, depression, or suicidal ideation.
• Renal Function: Dose adjustment may be necessary in patients with renal impairment.

Special Considerations

• Pregnancy: Category C; potential benefits may warrant use in pregnant women despite potential risks.
• Breastfeeding: Levetiracetam is excreted in breast milk; use with caution.
• Pediatric Use: Approved for use in children, with specific dosing guidelines based on age and weight.
• Geriatric Use: Dose adjustment may be necessary due to potential renal function decline.

Storage

• Tablets and Solution: Store at room temperature, away from light and moisture.
• Intravenous Solution: Follow specific storage guidelines provided by the manufacturer.

Patient Counseling Information

• Compliance: Emphasize the importance of taking the medication regularly and as prescribed.
• Side Effects: Inform about common side effects and when to seek medical attention.
• Behavioral Changes: Advise caregivers and patients to report any new or worsening mood symptoms.

Research and Development

• Ongoing Studies: Research continues to explore the full mechanism of action and potential new therapeutic uses of levetiracetam.

Regulatory Status

• FDA Approval: Initially approved in 1999 for the treatment of epilepsy.
• Worldwide Availability: Available in many countries under various brand names.