Pharm

Levetiracetam

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Levetiracetam, Keppra

  • 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)
  • 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)
  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
  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
  • 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
  • Safety
  1. Safe in children
  2. Pregnancy Category C
  • References
  1. LoVecchio and Pringle (2018) Crit Dec Emerg Med 32(12): 28
  2. Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]