levetiracetam

levetiracetam /le·ve·ti·rac·e·tam/ (le″vĕ-ti-ras´ĕ-tam) an anticonvulsant used in the treatment of partial seizures in adults with epilepsy.

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levetiracetam,

an anticonvulsant.

indication It is used to treat partial onset seizures.

contraindication Known hypersensitivity to this drug prohibits its use.

adverse effects Adverse effects include lowered hematocrit, lowered hemoglobin, infection, dizziness, somnolence, and asthenia.

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levetiracetam

Keppra

Pharmacologic class: Pyrrolidine derivative

Therapeutic class: Anticonvulsant

Pregnancy risk category C

Action

Unknown. Thought to prevent seizures by inhibiting nerve impulses in hippocampus of brain. Chemically unrelated to other anticonvulsants.

Availability

Oral solution: 100 mg/ml

Solution for injection: 500 mg/5 ml in single-use 5-ml vial

Tablets: 250 mg, 500 mg, 750 mg

⊘Indications and dosages

➣ Adjunctive treatment of partial seizures

Adults and children ages 16 and older: 500 mg P.O. b.i.d. May increase by 1,000 mg/day q 2 weeks to a maximum daily dosage of 3,000 mg, as needed. Or, when oral administration is temporarily not feasible, give initial daily I.V. dosage equivalent to total daily dosage and frequency of oral drug.

Dosage adjustment

• Renal impairment (especially in dialysis patients)

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• renal, hepatic, or cardiac impairment
• psychosis
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established).

Administration

• Give with or without food.
☞ Be aware that injection form is for I.V. use only and must be diluted before administering.
• Dilute 500 mg/ml in 100 ml 0.9% normal saline injection, lactated Ringer's injection, or dextrose 5% injection. Withdraw 5 ml, 10 ml, or 15 ml for 500-mg, 1,000-mg, or 1,500-mg dose, respectively.
• Administer as a 15-minute I.V. infusion.
☞ Don't discontinue suddenly. Instead, taper dosage gradually.

Route	Onset	Peak	Duration
P.O.	Rapid	1 hr	Unknown
I.V.	Rapid	Unknown	Unknown

Adverse reactions

CNS: aggression, anger, irritability, mental or mood changes, asthenia, ataxia, dizziness, drowsiness, somnolence, fatigue, nervousness, depression, anxiety, amnesia, hostility, coordination difficulties, headache, paresthesia, vertigo

EENT: diplopia, pharyngitis, rhinitis, sinusitis

GI: nausea, vomiting, anorexia

Hematologic: neutropenia, leukopenia

Respiratory: cough

Other: infection, pain

Interactions

Drug-herbs. Evening primrose oil: lowered seizure threshold

Patient monitoring

• Measure temperature and watch for signs and symptoms of infection.
☞ Monitor neurologic status. Report signs that patient is dangerous to himself or others.
• Evaluate nutritional status. Report signs of anorexia.

Patient teaching

• Tell patient to take with or without food.
☞ Advise family to contact prescriber if patient poses a danger to himself or others.
☞ Caution patient not to stop taking drug abruptly, because doing so may increase seizure activity.
• Teach patient and family about adverse CNS reactions, and tell them to report these promptly. Urge them to take safety measures to prevent injury.
• Instruct patient to avoid activities that require mental alertness until CNS reactions are known.
• Inform patient that he'll undergo periodic blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the herbs mentioned above.

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levetiracetam

Neurology An antiepileptic adjunct for adults with partial-onset seizures with/without secondary generalization. See Seizures.