Levetiracetam | Epilepsy clinician handbook
Levetiracetam has a broad efficacy profile and can be useful in multiple seizure types (focal, generalised, myoclonic).
Overall, side-effect profile is good, with minimal drug interactions.
PBS indication: Partial epileptic seizures
Clinical criteria:
- The condition must have failed to be controlled satisfactorily by other anti-epileptic drugs; OR
- Patient must be a woman of childbearing potential,
and
- The treatment must not be given concomitantly with brivaracetam, except for cross titration.
Important: Dosing information
Initiation and escalation doses on this webpage are a guide only.
All medications must be individualised based on:
- patient age, weight, co-morbidities
- disease, seizure type, frequency, duration
- medication metabolism, interactions, side-effect profile characteristics.
Further consultation with appropriate formularies or a paediatric neurologist may be required.
Dosing
Commonly used regime
- Target dose 20-40mg/kg/day in two divided doses. Higher doses may be used (for example up to 60mg/kg).
- Start 10-20mg/kg/day in two divided doses, increasing each 2 weeks by 10mg/kg/day.
- Recommended maximum adult dosage: 1.5 grams bd.
- Dosages per kilogram can only be used up to weights of 30-40kgs.
Using intravenous formulation, levetiracetam can be used in emergency situations, e.g. status epilepsy. A similar dosage is used for intravenous administration if the patient is already on oral levetiracetam.
Preparations
- Oral solution 100mg/ml or Tablet 250mg, 500mg, 1,000mg.
- There is an intravenous form.
Monitoring
- No drug level monitoring is currently available.
Formulary
Possible side effects
- Drowsiness or somnolence.
- Disturbed behaviour, agitation or emotional lability, or mood changes can occur. Aggressiveness may be as frequent as 1 in 5.
- Drug withdrawal must be strongly considered if suicidal ideation occurs.
- Rash is uncommon.
- Rarely, a neutropenia, thrombocytopenia or liver dysfunction may occur.
- All anti-seizure medications are potentially teratogenic and this is often dose related.
For a complete list of adverse effects, appropriate formularies should be consulted.
Interactions and precautions
There are minimal drug interactions. No drug level monitoring is currently available.
Resources
This information is reviewed annually by the Sydney Children’s Hospitals Network Paediatric Epilepsy NSW working group which includes medical, nursing, and pharmacy representation.