Levetiracetam

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General

  • Type: Anticonvulsants
  • Dosage Forms: PO 250, 500, 750, 1000; 500 ER, 750 ER; IV 100/mL
  • Common Trade Names: Keppra

Adult Dosing

  • Partial seizures, adjunct
    • 500-1500mg PO/IV q12h.
      • Start 500 q12 or 1000 QD, inc by 1000mg/day q2wk
      • Max 3000mg/day
  • Generalized tonic clonic seizures, adjunct
    • 1500mg PO/IV q12h
      • Start 500 q12, inc by 1000mg/day q2wk
      • Max 3000mg/day

Pediatric Dosing

  • Partial seizures, adjunct
    • 4-15 yo
      • 60mg/kg/day PO divided bid
      • Start 20mg/kg/day PO divided bid, inc by 20mg/kg/day q2wk
      • Max 3000mg/day
    • >16 yo
      • 500-1500mg PO/IV q12h.
      • Start 500 q12 or 1000 QD, inc by 1000mg/day q2wk
      • Max 3000mg/day
  • Generalized tonic clonic seizures, adjunct
    • 6-15 yo
      • 60mg/kg/day PO divided bid
      • Start 20mg/kg/day PO divided bid, inc by 20mg/kg/day q2wk
      • Max 3000mg/day
    • >16 yo
      • 1500mg PO/IV q12h
      • Start 500 q12, inc by 1000mg/day q2wk
      • Max 3000mg/day

Special Populations

  • Pregnancy Rating: C
  • Lactation: probably safe
  • Renal Dosing
    • Adult
      • CrCl 50-80: 500-1000mg q12h IR; 1000-2000mg QD ER
      • CrCl 30-50: 250-750mg q12h IR; 500-1500mg QD ER
      • CrCl <30: 250-500mg q12h; 500-1000mg QD ER
      • HD: 500-1000mg q24h IR, do not use ER
    • Pediatric
      • CrCl <50, IR: decrease dose 50%
      • CrCl 50-80: 1000-2000mg QD ER
      • CrCl 30-50: 500-1500mg QD ER
      • CrCl <30: 500-1000mg QD ER
  • Hepatic Dosing: no adjustment

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Depression
  • Hostility
  • Aggressive behavior
  • Psychosis
  • Suicidality
  • Leukopenia
  • Neutropenia
  • Drug rash with eosinophilia and systemic sx
  • Stevens-Johnson
  • Toxic epidermal necrolysis
  • Erythema multiforme
  • withdrawal seizures if abrupt discharge

Common

  • Somnolence
  • Asthenia
  • Vomiting
  • Headache
  • URI sx
  • Anorexia
  • Infection
  • Hostility
  • Fatigue
  • Nervousness
  • Dizziness
  • Diarrhea
  • Behavioral changes
  • Irritability
  • Pain
  • Agitation
  • Emotional lability
  • Depression
  • Nausea
  • Vertigo
  • Ataxia
  • Leukopenia
  • Neutropenia
  • Anxiety
  • Confusion
  • Amnesia
  • Alopecia

Pharmacology

  • Half-life: 6-8h
  • Metabolism: hydrolysis minimally
  • Excretion: urine
  • Mechanism of Action: exact mechanism unknown

See Also

Anticonvulsants

References

epocrates