Levetiracetam: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic | | generic = Levetiracetam | ||
| brand | | brand = Keppra (IR), Keppra XR, Spritam (3D-printed orally disintegrating), Roweepra | ||
| structure | | structure = | ||
| classes | | classes = [[:Category:Anticonvulsants|Anticonvulsant]], [[:Category:SV2A ligands|Synaptic vesicle protein 2A (SV2A) ligand]] | ||
| | | uses = <vote slug="partial-seizures-monotherapy-use">Partial-onset seizures (FDA, monotherapy and adjunct)</vote>, <vote slug="juvenile-myoclonic-epilepsy-use">Myoclonic seizures of juvenile myoclonic epilepsy (FDA, adjunct)</vote>, <vote slug="generalized-tonic-clonic-use">Primary generalized tonic-clonic seizures of idiopathic generalized epilepsy (FDA, adjunct)</vote>, <vote slug="status-epilepticus-second-line-use">Status epilepticus (off-label, second-line after benzodiazepine)</vote> | ||
| uses | | starting_dose = Adult: 500 mg PO BID, titrate by 1000 mg/day every 2 weeks. Pediatric: 10-20 mg/kg/day divided BID, weight-titrated | ||
| starting_dose | | preparations = IR tablets 250, 500, 750, 1000 mg; XR tablets 500, 750 mg; oral solution 100 mg/mL; injection 100 mg/mL; Spritam ODT 250, 500, 750, 1000 mg | ||
| preparations | | fda_max = 3000 mg/day | ||
| fda_max = | | pill_id = | ||
| routes | | routes = Oral, intravenous | ||
| onset | | onset = Anticonvulsant effect within days at therapeutic plasma level; rapid titration possible | ||
| duration | | duration = BID dosing (IR); once-daily (XR) | ||
| halflife | | halflife = 6-8 hours<ref name="keppra-label">FDA Prescribing Information, Keppra (levetiracetam), UCB, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021035s101lbl.pdf</ref> | ||
| bioavailability = ~100% (oral)<ref name="keppra-label" /> | |||
| pregnancy = '''Considered one of the safest anticonvulsants in pregnancy''', with reassuring monotherapy registry data comparable to lamotrigine and in sharp contrast to valproate, topiramate, and carbamazepine<ref name="keppra-label" /> | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US. Not a controlled substance<ref name="keppra-label" /> | |||
| | | mechanism = <vote slug="levetiracetam-mech-claim">Binds the synaptic vesicle protein 2A (SV2A), modulating presynaptic neurotransmitter release through a mechanism distinct from sodium channel, calcium channel, GABA, and glutamate receptor mechanisms of older anticonvulsants. The result is reduced neuronal hyperexcitability with minimal sedation or cognitive impact compared to most other anticonvulsants.</vote> The marquee adverse-effect concern is '''behavioral and psychiatric''': irritability, depression, agitation, anxiety, and suicidal ideation, with the AED-class FDA suicidality warning particularly associated with this agent. Pyridoxine (vitamin B6) supplementation may mitigate these in some patients. Renally eliminated; dose adjustment by creatinine clearance is required<ref name="keppra-label" />. | ||
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}} | }} | ||
== References == | |||
<references /> | |||
[[Category:Anticonvulsants]] | [[Category:Anticonvulsants]] | ||
[[Category:SV2A ligands]] | [[Category:SV2A ligands]] | ||
Latest revision as of 06:57, 23 May 2026
Levetiracetam
Keppra (IR), Keppra XR, Spritam (3D-printed orally disintegrating), Roweepra
Experience
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Summary
Common uses
Partial-onset seizures (FDA, monotherapy and adjunct)0, Myoclonic seizures of juvenile myoclonic epilepsy (FDA, adjunct)0, Primary generalized tonic-clonic seizures of idiopathic generalized epilepsy (FDA, adjunct)0, Status epilepticus (off-label, second-line after benzodiazepine)0
Pharmacy
Starting dose
Adult: 500 mg PO BID, titrate by 1000 mg/day every 2 weeks. Pediatric: 10-20 mg/kg/day divided BID, weight-titrated
Preparations
IR tablets 250, 500, 750, 1000 mg; XR tablets 500, 750 mg; oral solution 100 mg/mL; injection 100 mg/mL; Spritam ODT 250, 500, 750, 1000 mg
US FDA Max
3000 mg/day
Pharmacology
Routes
Oral, intravenous
Onset
Anticonvulsant effect within days at therapeutic plasma level; rapid titration possible
Duration
BID dosing (IR); once-daily (XR)
Half-life
6-8 hours[1]
Bioavailability
~100% (oral)[1]
Pregnancy
Considered one of the safest anticonvulsants in pregnancy, with reassuring monotherapy registry data comparable to lamotrigine and in sharp contrast to valproate, topiramate, and carbamazepine[1]
Purported mechanism
Binds the synaptic vesicle protein 2A (SV2A), modulating presynaptic neurotransmitter release through a mechanism distinct from sodium channel, calcium channel, GABA, and glutamate receptor mechanisms of older anticonvulsants. The result is reduced neuronal hyperexcitability with minimal sedation or cognitive impact compared to most other anticonvulsants.0 The marquee adverse-effect concern is behavioral and psychiatric: irritability, depression, agitation, anxiety, and suicidal ideation, with the AED-class FDA suicidality warning particularly associated with this agent. Pyridoxine (vitamin B6) supplementation may mitigate these in some patients. Renally eliminated; dose adjustment by creatinine clearance is required[1].