Levetiracetam
Levetiracetam
Keppra (IR), Keppra XR, Spritam (3D-printed orally disintegrating), Roweepra
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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].