Levetiracetam
Mechanism
Its precise antiseizure mechanism is not fully established. Binding to synaptic vesicle protein SV2A may help regulate vesicle exocytosis and contribute to its antiseizure activity.
Uses
- Partial-onset seizures
- Myoclonic seizures in juvenile myoclonic epilepsy
- Primary generalized tonic-clonic seizures
Administration
- Immediate release products are generally divided into twice-daily administration
- Pediatric dosing depends on age and body weight
- Adult dosing must be adjusted for renal impairment
- Avoid abrupt withdrawal because seizure frequency and status epilepticus can increase
Common effects
- Somnolence
- Fatigue or asthenia
- Dizziness
- Behavioral changes or irritability
Serious risks
- Suicidal thoughts or behavior
- Psychotic symptoms or marked behavioral change
- Anaphylaxis or angioedema
- Serious skin reactions and DRESS
- Withdrawal seizures
Contraindications
- Known hypersensitivity to levetiracetam, including previous anaphylaxis or angioedema
Interactions
- Clinically important CYP-mediated pharmacokinetic interactions are unlikely
- Label studies found no meaningful pharmacokinetic effect with phenytoin, valproate, warfarin, digoxin, or a studied combined oral contraceptive
- Review concomitant medicines that may worsen somnolence or impaired coordination
Monitoring
- Seizure frequency and adherence
- Mood, behavior, and suicidal thinking
- Somnolence, gait, and coordination
- Renal function for dose selection
- Rash, fever, or evidence of systemic hypersensitivity
Counseling
- Do not stop the medication abruptly
- Avoid driving until individual effects are understood
- Report new aggression, depression, unusual behavior, or suicidal thoughts promptly
- Seek care for facial swelling, breathing difficulty, rash, fever, or swollen lymph nodes