Levetiracetam

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

Authors

Charley Randazzo, Neil Young, Daniel Ostermayer, Ross Donaldson