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Oral liquid bottle $44.80, Tablet $0.15, Vial $3.90

Levetiracetam

Editor: Updated Class:

ADMINISTRATION ROUTES:

IV, PO, NG

ALTERNATIVE NAMES:

Keppra, levetiracetam-AFT

ICU INDICATIONS:

  1. Seizures and seizure prophylaxis

PRESENTATION AND ADMINISTRATION:

IV:

500 mg in 5 mL solution

Dilute dose in 100 mL of compatible fluid and give over 15 minutes

Compatible with the following fluids: 0.9% Normal saline, 5% dextrose, Hartmann's solution

Store at room temperature, discard if solution forms precipitates or becomes discoloured. Prepared infusions are stable for 6 hours at room temperature

PO / NG:

Film coated tablets. Tablets may be crushed and mixed with water for NG administration

DOSAGE:

Oral and IV doses are the same

Status epilepticus:

Loading dose:

60 mg/kg to maximum 4500 mg

Dilute in 100 mL 0.9% Normal saline or 5% dextrose & give over 15 mins

Maintenance dose:

500 - 1500 mg BD

Increase to maximum dose 2000 mg BD if needed

Seizure prophylaxis in traumatic brain injury or subarachnoid haemorrhage:

Loading dose:

20 mg/kg over 15 mins

Maintenance dose:

1000 mg BD

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Loading dose not affected by renal impairment

Dose in renal impairment

GFR (ml/min) DOSE
<15 250-500 mg OD
15-29 250-500 mg BD
30-49 250-750 mg BD
50-79 500-1000 mg BD

Dose in renal replacement therapy

MODALITY DOSE
CAPD 250-500 mg OD
HD 500-1000 mg OD given after dialysis
CVVHDF 750-1000 mg BD

No dose adjustment is required in patients with mild to moderate hepatic impairment

DOSAGE IN PAEDIATRICS:

Not recommended in infants and children under 4 years

IV:

Status epilepticus:

Loading dose:

40 - 60 mg/kg diluted to a maximal concentration 50 mg/mL

Dilute in 0.9% Normal saline or 5% dextrose & give over 15 mins

PO:

Age 4-16 and ≤ 50kg

10 mg/kg BD Increase to maximum dose 30 mg/kg BD if needed

Over 50kg

Dose as per adults

CLINICAL PHARMACOLOGY:

Exact mechanism of action is unknown. May modulate neurotransmission by binding to synaptic vesicle protein 2A. Also affects intraneuronal calcium levels by reducing release from stores.

CONTRAINDICATIONS:

Hypersensitivity to levetiracetam

WARNINGS:

Use in pregnancy:

Levetiracetam should only be used during pregnancy if potential benefits justifies potential risk to fetus

Use in breastfeeding:

Levetiracetam is excreted in human breast milk. Decisions around discontinuation of drug should take into account importance of the drug to the mother

PRECAUTIONS:

General:

Learning disability, history of psychiatric problems - increased risk of behavioural problems

Laboratory Test:

No specific tests are required

Drug/Laboratory Test Interactions:

None noted

IMPORTANT DRUG INTERACTIONS IN ICU:

Methotrexate:

Levetiracetam may increase methotrexate concentration when anti-neoplastic doses used. Monitor for toxicity and consider methotrexate concentration monitoring

Antidepressants:

SSRIs & tricyclic antidepressants may decrease levetiracetam levels or effect

ADVERSE REACTIONS:

Body as a Whole:

Myalgia, malaise, rash

Digestive System:

Anorexia, nausea, vomiting, diarrhoea, pancreatitis

Nervous System:

Drowsiness, headache, behavioural effects, ataxia, aggression, depression, insomnia, irritability, psychosis, blurred vision, diplopia

Skin:

Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, DRESS, alopecia

Haematological System:

Leucopenia, thrombocytopenia, pancytopenia