Levetiracetam = LEV oral

Therapeutic action

Antiseizure (antiepileptic).

Indications

Due to the numerous and potentially severe adverse effects of LEV, patients should be kept under close surveillance.

Epilepsy: generalised tonic-clonic seizures, focal partial seizures, and absence seizures.

Forms and strengths

• 250 mg, 500 mg, 750 mg, and 1 g tablets.
• 500 mg/5 ml oral solution, to be administered using a measuring device.

Dose

Start with a low dose then increase gradually based on patient response and tolerance.

• Child 1 to 5 months: start with 7 mg/kg once daily; increase to 7 mg/kg 2 times daily after 2 weeks, then by increments of 7 mg/kg 2 times daily every 2 weeks if necessary, maximum 21 mg/kg 2 times daily.
• Child 6 months to 17 years and under 50 kg: start with 10 mg/kg once daily; increase to 10 mg/kg 2 times daily after 2 weeks, then by increments of 10 mg/kg 2 times daily every 2 weeks if necessary, maximum 30 mg/kg 2 times daily.
• Child 50 kg and over and adult: start with 250 mg 2 times daily; increase to 500 mg 2 times daily after 2 to 4 weeks, then by increments of 500 mg 2 times daily every 2 to 4 weeks if necessary, maximum 1.5 g 2 times daily.

Duration

As long as required. Do not stop treatment abruptly, even if changing to another antiseizure medication.

Contra-indications, adverse effects, precautions

• Administer with caution to patients with renal impairment by reducing dosage, or with heart disorders.
• May cause drowsiness, headache, asthenia, dizziness, mood and behavioural disturbances, anxiety, depression, insomnia, haematological disorders, gastrointestinal disturbances, cough, and nasopharyngitis.
• Rarely, may cause QT prolongation and severe hypersensitivity reactions. In these cases stop treatment. Early symptoms such as fever, rash, mouth ulcers, and bleeding require immediate medical attention.
• Respiratory depression and coma may occur in overdose.
• Avoid or monitor the combination with mefloquine, drugs that prolong the QT interval, and sedating medicines including alcohol, benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines, antidepressants, and other antiseizure medications.
• Avoid alcohol during treatment.
• Pregnancy: use the lowest effective dose and administer folic acid 5 mg daily during the first trimester.
• Breast-feeding: administer with caution and monitor the child for drowsiness and poor feeding.