ADMINISTRATION ROUTES:
IV, PO, NG
ALTERNATIVE NAMES:
Keppra, levetiracetam-AFT
ICU INDICATIONS:
- 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