Levetiracetam

Anti-epileptic · Pyrrolidone derivative

Indications

Adjunct in partial seizures with or without secondary generalization.

Dosage

Adults: Monotherapy of focal seizures: ORAL or IV INFUSION: Initially 250 mg once daily increased after 1-2 wk to 250 mg twice daily, increased according to response in steps of 250 mg twice daily every 2 wk. Max: 1.5 gm twice daily. Adjunctive therapy of focal seizures: ORAL: Body-weight >50 kg, initially 250 mg twice daily, increased by 500 mg twice daily every 2-4 wk. Max: 1.5 gm twice daily. Body-weight <50 kg, initially 10 mg/kg once daily, increased by max 10 mg/ kg twice daily every 2 wk. Max: 30 mg/kg twice daily. IV INFUSION: Body-weight >50 kg, initially 250 mg twice daily, increased by 500 mg twice daily every 2-4 wk. Max 1.5 gm twice daily. Body-weight <50 kg, initially 10 mg/kg once daily, increased by max 10 mg/kg twice daily every 2 wk. Max: 30 mg/kg twice daily. Adjunctive therapy of myoclonic seizures and tonic-clonic seizures: ORAL or IV INFUSION: Body-weight >50 kg,…

Administration

IV: Dilute prescribed dose in 100 mL of a compatible diluent and infuse over 15 min. Compatibility: Dextrose 5%, NaCl 0.9%, LR. Stability: Final dilution stable for at least 24 hours at controlled room temperature.

Adverse Effects

Accidental injury, headache, anorexia, GI upset, asthenia, ataxia, somnolence, amnesia, convulsions, dizziness, depression, emotional lability, hostility, insomnia, nervousness, tremor, vertigo, skin rash, diplopia, nasopharyngitis, anxiety, irritability, balance disorder, Reports of acute kidney injury.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Precautions: Renal or severe hepatic impairment. Withdraw slowly. Elderly. Monitor patients for suicidal thoughts or behaviour. Risk of decreased blood cell counts; perform FBC in patients with significant weakness, pyrexia, recurrent infection or coagulation disorders.

Interactions

Methotrexate, Macrogol.

Advice to Patient

Take oral form with or without meals. Oral solution may be diluted in a glass of water or taken directly. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is change in mental status, aggression, depression, change in memory, change in gait, muscle cramps, weakness, tremors, constipation, vomiting, loss of appetite, unusual bruising or bleeding, blood in urine/mouth/stool, skin rash, skin irritation, loss of control on seizure or if there is worsening of condition. Avoid alcohol during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Carry identification card mentioning you have epilepsy and names of all medications you take. Keep follow-up appointments with prescriber. On start of therapy or change of dosage, patient must be watched for suicidal tendency…

Pharmacokinetics

Absorption: Oral: Rapid and almost complete. Immediate release: Food decreases Cmax by 20% and delays time to Cmax (Tmax) by 1.5 hrs. Extended release: Intake of a high-fat, high-calorie breakfast before the administration results in a higher Cmax and longer median Tmax; the median Tmax is 2 hrs longer in the fed state. Metabolism: Not extensive; hydrolysis occurs primarily in the blood. Bioavailability: 100%; bioavailability of extended release tabs is similar to immediate release tabs; tablets, oral soln and inj are bioequivalent. Half-life elimination: Increased in patients with renal impairment: Infants and Children <4 yrs: 5.3 ± 1.3 hrs. Children 4-12 yrs: 6 ± 1.1 hrs. Adults: Approx. 6-8 hrs; extended release tab: Approx. 7 hrs. Time to peak, plasma: Oral soln: Fasting Infants and Children <4 yrs: 1.4 ± 0.9 hrs. Oral: Immediate release: Fasting Adults and Children: Approx. 1 hr.…

Brands with this active ingredient

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