II. Indications

  1. Status Epilepticus
  2. Seizure Prophylaxis
    1. Focal onset Seizures (FDA Approved)
    2. Juvenile Myoclonic Epilepsy (FDA approved for ages >12 years)
    3. Primary Generalized Tonic Clonic Seizures (FDA approved for ages >6 years)

III. Mechanism

  1. Broad spectrum anticonvulsant
  2. Binds Glycoprotein 2A at the synaptic Vesicle and may alter Vesicle fusion
  3. May also affect gamma-aminobutyric acid (GABA)

IV. Dosing: Seizure Prophylaxis in Adults

  1. Start: 1000 mg/day orally divided twice daily
  2. Titrate every 2 weeks (increase dose by 1000 mg)
  3. Typical target dose: 3000 mg/day (or 80 mg/kg/day) divided twice daily
  4. Target serum concentration: 12 to 46 mcg/ml
  5. Maximum: 4000 mg/day
  6. Intravenous infusion dose is bioequivalent to oral dose
    1. Load: 20-30 mg/kg IV at 5 mg/kg/min

V. Dosing: Status Epilepticus

  1. Dose: 60 mg/kg IV (or 2.5 g in adults, up to 4.5 g maximum) over 5 to 15 min for single dose

VI. Adverse Effects

  1. Most common
    1. Fatigue
    2. Somnolence
    3. Dizziness
  2. Psychiatric symptoms
    1. Agitation
    2. Anxiety
    3. Depressed mood
  3. Other symptoms
    1. Irritability
    2. Rash

VII. Safety

  1. Safe in children
  2. Pregnancy Category C

VIII. References

  1. LoVecchio and Pringle (2018) Crit Dec Emerg Med 32(12): 28
  2. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]

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Related Studies

Cost: Medications

levetiracetam (on 5/31/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
LEVETIRACETAM 1,000 MG TABLET Generic $0.29 each
LEVETIRACETAM 100 MG/ML SOLN Generic $0.04 per ml
LEVETIRACETAM 250 MG TABLET Generic $0.09 each
LEVETIRACETAM 500 MG TABLET Generic $0.10 each
LEVETIRACETAM 750 MG TABLET Generic $0.17 each
LEVETIRACETAM ER 500 MG TABLET Generic $0.40 each
LEVETIRACETAM ER 750 MG TABLET Generic $0.54 each
keppra (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
KEPPRA 1,000 MG TABLET Generic $0.29 each
KEPPRA 100 MG/ML ORAL SOLN Generic $0.04 per ml
KEPPRA 250 MG TABLET Generic $0.09 each
KEPPRA 500 MG TABLET Generic $0.10 each
KEPPRA 750 MG TABLET Generic $0.17 each
KEPPRA XR 500 MG TABLET Generic $0.40 each
KEPPRA XR 750 MG TABLET Generic $0.54 each

Ontology: Levetiracetam (C0377265)

Definition (NCI) A pyrrolidine with antiepileptic activity. The exact mechanism through which levetiracetam exerts its effects is unknown but does not involve inhibitory and excitatory neurotransmitter activity. Stereoselective binding of levetiracetam was confined to synaptic plasma membranes in the central nervous system with no binding occurring in peripheral tissue. Levetiracetam inhibits burst firing without affecting normal neuronal excitability, which suggests that it may selectively prevent hyper-synchronization of epileptiform burst firing and propagation of seizure activity.
Definition (NCI_NCI-GLOSS) A drug used to treat seizures (involuntary muscle movements) caused by epilepsy (a group of brain disorders). Keppra is being studied in the treatment of seizures in patients with cancer that has spread to the brain. It is a type of anticonvulsant.
Definition (PDQ) A pyrrolidine with antiepileptic activity. The exact mechanism through which levetiracetam exerts its effects is unknown but does not involve inhibitory and excitatory neurotransmitter activity. Stereoselective binding of levetiracetam was confined to synaptic plasma membranes in the central nervous system with no binding occurring in peripheral tissue. Levetiracetam inhibits burst firing without affecting normal neuronal excitability, which suggests that it may selectively prevent hyper-synchronization of epileptiform burst firing and propagation of seizure activity. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=526173&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=526173&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C47581" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C026098
SnomedCT 323049001, 116076009, 387000003
LNC LP28566-5, MTHU014314
English (S)-alpha-Ethyl-2-oxo-1-pyrrolidineacetamide, 1-Pyrrolidineacetamide, Alpha-ethyl-2-oxo-,(S)-, levetiracetam, (S)-alpha-ethyl-2-oxo-1-pyrrolidineacetamide, 1-pyrrolidineacetamide, alpha-ethyl-2-oxo-,(S)-, levetiracetam (medication), LEVETIRACETAM, levETIRAcetam, LevETIRAcetam, Levetiracetam, Levetiracetam (product), Levetiracetam (substance), etiracetam, S-isomer
Spanish levetiracetam (producto), levetiracetam (sustancia), levetiracetam

Ontology: Keppra (C0876060)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C026098
English levetiracetam (Keppra), keppra, UCB Brand of Levetiracetam, Keppra