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an anticonvulsant administered orally as an adjunct in the treatment of partial seizures in adults with epilepsy.


Apo-Levetiracetam (CA), Co Levetiracetam (CA), Dom-Levetiracetam (CA), Keppra, Keppra XR, PHL-Levetiracetam, PMS-Levetiracetam (CA)

Pharmacologic class: Pyrrolidine derivative

Therapeutic class: Anticonvulsant

Pregnancy risk category C


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


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, 1,000 mg

Tablets (extended-release): 500 mg

Indications and dosages

Adjunctive treatment of partial-onset seizures in patients with epilepsy

Adults and children ages 16 and older: Initially, 500 mg P.O. (immediate-release preparations) 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, initially 1,000 mg P.O. (extended-release tablets) once daily. Adjust in increments of 1,000 mg q 2 weeks to a maximum daily dosage of 3,000 mg, as appropriate. Or, when oral administration is temporarily not feasible, give initial daily I.V. dosage equivalent to total daily dosage and frequency of oral drug.

Children ages 4 to 15: Initially, 20 mg/kg/day P.O. (immediate-release preparations) in two divided doses (10 mg/kg b.i.d.). Increase daily dosage every 2 weeks by increments of 20 mg/kg to recommended daily dosage of 60 mg/kg (30 mg/kg b.i.d.). If patient can't tolerate daily dosage of 60 mg/kg, reduce daily dosage.

Myoclonic seizures in patients with juvenile myoclonic epilepsy

Children ages 16 and older: Initially, 500 mg I.V. b.i.d. Increase dosage by 1,000 mg/day every 2 weeks to recommended total daily dosage of 3,000 mg.

Children ages 12 and older: Initially, 500 mg P.O. (immediate-release tablets or oral solution) b.i.d. Increase dosage by 1,000 mg/day every 2 weeks to the recommended total daily dose of 3,000 mg.

Primary generalized tonic-clonic seizures

Adults and children ages 16 and older: Initially, 1,000 mg P.O. b.i.d. Increase dosage by 1,000 mg/day every 2 weeks to the recommended total daily dose of 3,000 mg.

Children ages 6 to 15: Initially, 10 mg/kg P.O. b.i.d. Increase daily dosage every 2 weeks by increments of 20 mg/kg to recommended total daily dosage of 60 mg/kg (30 mg/kg b.i.d.).

Dosage adjustment

• Renal impairment (especially in dialysis patients)


• Hypersensitivity to drug or its components


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


• Give oral form with or without food.
• Know that patients weighing 44 lb (20 kg) or less should be given oral solution.
• Be aware that injection form is intended for temporary use when oral route isn't feasible.

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.

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


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.
• Instruct patient to swallow extended-release tablets whole and not to chew, break, or crush them.

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.


/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.


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.


Neurology An antiepileptic adjunct for adults with partial-onset seizures with/without secondary generalization. See Seizures.
References in periodicals archive ?
Key words: seizure disorders, anticonvulsive, levetiracetam, pharmacokinetics, plasma concentrations, avian, Hispaniolan Amazon parrot, Amazona ventralis
In fact, levetiracetam provided seizure control comparable with that of older antiepileptic drugs (AEDs) carbamazepine and valproate but superior when compared with other newer AEDs, including lamotrigine and topiramate.
The top-line results indicate that the study met its primary endpoint by demonstrating that a comparable proportion of patients on Lyrica achieved at least a 50 percent reduction in the 28-day seizure rate during the maintenance phase relative to levetiracetam.
We observed that migraine attacks improved to a great extent with sodium valproate in our patient at the time when we could not obtain a response with analgesics and levetiracetam.
Until larger human trials have been completed, we caution against any off-label use of levetiracetam," Dr.
Other augmenting agents that have shown some promise in limited reports include clomipramine, venlafaxine, lithium, and levetiracetam.
These medications include felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), topiramate (Topamax), tiagabine (Gabitril), levetiracetam (Keppra), oxcarbazepine (Trileptal), zonisamide (Zonegran), and pregabalin (Lyrica; Stevens, 2006).
Antimyoclonic drugs were progressively administered, including piracetam (36 g/day intravenously), subsequently replaced by levetiracetam (4000 mg/day p.
Following our speculation regarding a possible association between the symptoms and the medication, the levetiracetam was tapered and eventually discontinued.
The National Institute of Clinical Excellence (Nice) said drugs including gabapentin, lamotrigine and levetiracetam were recommended for the management of epilepsy in people who had not benefited from older drugs.
But a subanalysis of the cohort that looked at 15 different AEDs, including barbiturates and conventional drugs, found that only levetiracetam significantly increased the odds of suicidal behavior or self-harm (odds ratio, 6.
Newer drugs with a higher risk of causing depression than other epilepsy drugs, such as levetiracetam, topiramate and vigabatrin, were found to increase the risk of self-harm or suicidal behavior among people with epilepsy.