LEVETIRACETAM

LEVETIRACETAM
(lev-e-tir'a-ce-tam)
Keppra
Classifications: anticonvulsant;
Therapeutic: anticonvulsant
Pregnancy Category: C

Availability

250 mg, 500 mg, 750 mg tablets; 100 mg/mL oral solution

Action

The precise mechanism of antiepileptic effects is unknown. It is a broad spectrum antiepileptic agent, which does not involve GABA inhibition. It prevents epileptiform burst firing and propagation of seizure activity.

Therapeutic Effect

Inhibits complex partial seizures and prevents epileptic and seizure activity.

Uses

Adjunctive therapy for partial onset, myoclonic, tonic clonic seizures.

Contraindications

Hypersensitivity to levetiracetam; labor; pregnancy (category C), lactation; children <4 y; suicidal ideation.

Cautious Use

Renal impairment; renal disease; renal failure; older adults; history of psychosis or depression, suicidal tendencies.

Route & Dosage

Partial Onset Seizures
Adult: PO 500 mg b.i.d., may increase by 500 mg b.i.d. q2wk (max: 3000 mg/d)
Child (4–16 y): PO 20 mg/kg/d in 2 divided doses; may increase by 20 mg/kg q2wk up to 60 mg/kg/d

Tonic Clonic Seizures
Adult/Adolescent (>16 y): PO 500 mg b.i.d., increase by 1000 mg q2wk to dose of 3000 mg/d
Child (>6 y): PO 10 mg/kg b.i.d., increase by 20 mg/kg q2wk to dose of 60 mg/kg/d in 2 doses

Renal Impairment
Cl_cr 50–80 mL/min: 500–1000 mg q12h; 30–50 mL/min: 250–750 mg q12h; <30 mL/min: 250–500 mg q12h
Hemodialysis: 500–1000 mg q24h

Administration

Oral

Reduced doses are indicated when creatinine clearance is <80 mL/min.
Make dosage increment changes at 2-wk intervals.
Taper dose if discontinued.
Give supplemental doses to dialysis patients after dialysis.
Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Asthenia, headache, infection, pain. CNS: Somnolence, amnesia, anxiety, ataxia, depression, dizziness, emotional lability, hostility, nervousness, vertigo, paradoxical increase in seizures (as add-on therapy). GI: Anorexia. Respiratory: Cough, pharyngitis, rhinitis, sinusitis. Special Senses: Diplopia. Other: Increased symptoms of depression; suicidal ideation.

Interactions

Drug: Levetiracetam does not decrease estrogen, warfarin, or digoxin levels or affect levels of other antiepileptic drugs.

Pharmacokinetics

Absorption: Rapidly and almost completely absorbed. Peak: 1 h; steady-state 2 d. Distribution: <10% protein bound. Metabolism: Minimal hepatic metabolism. Elimination: Renally eliminated. Half-Life: 7.1 h (9.6 h in older adults).

Nursing Implications

Assessment & Drug Effects

Monitor individuals with a history of psychosis or depression for signs and symptoms of suicidal tendencies, suicidal ideation, and suicidality. Report any of these symptoms to the physician.
Monitor & notify physician of difficulty with gait or coordination.
Lab tests: Periodic CBC with differential, Hct & Hgb, LFTs.
Monitor for changes in phenytoin blood levels with coadministered drugs.

Patient & Family Education

Monitor for signs and symptoms of suicidality, especially in children with a history of depression or psychosis.
Do not drive or engage in potentially hazardous activities until response to drug is known.
Do not abruptly discontinue drug. MUST use gradual dose reduction/taper.
Notify physician of intention to become pregnant.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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