Pharm
Levetiracetam
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Levetiracetam
, Keppra
Indications
Status Epilepticus
Seizure Prophylaxis
Focal onset
Seizure
s (FDA Approved)
Juvenile Myoclonic
Epilepsy
(FDA approved for ages >12 years)
Primary
Generalized Tonic Clonic Seizure
s (FDA approved for ages >6 years)
Mechanism
Broad spectrum anticonvulsant
Binds glycoprotein 2A at the synaptic
Vesicle
and may alter
Vesicle
fusion
May also affect gamma-aminobutyric acid (GABA)
Dosing
Seizure Prophylaxis
in Adults
Start: 1000 mg/day orally divided twice daily
Titrate every 2 weeks (increase dose by 1000 mg)
Typical target dose: 3000 mg/day (or 80 mg/kg/day) divided twice daily
Target serum concentration: 12 to 46 mcg/ml
Maximum: 4000 mg/day
Intravenous infusion dose is bioequivalent to oral dose
Load: 20-30 mg/kg IV at 5 mg/kg/min
Dosing
Status Epilepticus
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
Most common
Fatigue
Somnolence
Dizziness
Psychiatric symptoms
Agitation
Anxiety
Depressed mood
Other symptoms
Irritability
Rash
Safety
Safe in children
Pregnancy Category C
References
LoVecchio and Pringle (2018) Crit Dec Emerg Med 32(12): 28
Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]
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