Levetiracetam - A Novel Antiepileptic Drug

Overview:

Levetiracetam is used alone or with other medications to treat epilepsy. The Food and Drug Administration (FDA) approved drug is a novel antiepileptic drug used to treat partial, myoclonic, and tonic-clonic seizures. The favorable safety profile, distinct mechanism of action, and fewer drug interactions make Levetiracetam an excellent therapeutic choice for treating seizures.

Drug Group:

Levetiracetam is an anticonvulsant that may be used with other medications to treat seizures. The other drugs in the same class include Carbamazepine and Valproate. The anticonvulsant helps to decrease the hyperactivity of the brain. It is a prescription medicine to treat seizures in both adults and children.

What Is Levetiracetam Used to Treat?

• Levetiracetam is widely used as adjunctive therapy in treating myoclonic seizures in adults and juvenile myoclonic epilepsy in adolescents 12 years and older.
• The drug controls partial-onset seizures in adults, children, and infants one month or older.
• Levetiracetam is combined with other medications to treat seizures in adults and children older than 12. It is used as adjunctive therapy for treating primary generalized tonic-clonic seizures involving the entire body in children six years or older with epilepsy.
• Levetiracetam is used off-label for status epilepticus and seizure prophylaxis in subarachnoid hemorrhage.

How Does Levetiracetam Work?

Levetiracetam acts by binding to a synaptic vesicle protein 2A (SV2A). This protein is a part of secretory vesicle membranes that mediate calcium-dependent vesicular and GABA (gamma-aminobutyric acid)

neurotransmitter release. The binding of Levetiracetam to SV2A decreases the rate of vesicle release and increases the amount of GABA (gamma-aminobutyric acid)neurotransmitter, which reduces seizure activity. Levetiracetam has a calming effect on hyperactivity and stabilizes electrical activity in the brain.

What Is the Onset of Action of Levetiracetam?

Levetiracetam is rapidly and completely absorbed after oral intake and has a high bioavailability of 96 %. Peak plasma concentration is achieved one hour after oral administration. The presence of food may delay the time to attain maximum concentration by half an hour. 10 % of it is protein-bound as it does not compete with other drugs for protein-binding sites. 66 % of Levetiracetam is excreted unchanged by kidneys. The metabolites are excreted through glomerular filtration with partial tubular reabsorption. The plasma half-life is about six to eight hours in the elderly as creatinine clearance decreases with age. The peak plasma concentration is five to fifteen minutes with intravenous use.

Habit-forming:

Levetiracetam is not a drug of abuse and does not cause any addiction to people using it in the long term.

Expiry Date:

Avoid taking Levetiracetam medicine after it expires. The expiry date will usually be printed on the back of the pack.

What Is the Dosage of Levetiracetam?

Levetiracetam is available in oral and intravenous formulations. The oral medication is in immediate-release and extended-release forms; the minimum recommended dose is 55 mg twice daily, while the maximum recommended dose is 3000 mg daily.

Intravenous use of Levetiracetam is used only as an alternative for patients when oral administration is not possible.

How to Use Levetiracetam?

Levetiracetam is started at a low dose and gradually increases. Take Levetiracetam at about the same time each day for the best effect. It is advised to take it twice a day. The drug is taken with or without food. Do not take more or less than prescribed by the doctor. Always swallow the tablet whole and do not cut or chew the tablet.

Levetiracetam tablets for suspension can be dissolved in water. However, using a marked measuring spoon for oral solutions is advised.

Missed Dose:

If you miss a dose of Levetiracetam, skip the missed dose. It is advised not to take a double dose to cover for the missed dose.

What Are the Drug Warnings and Precautions?

Before taking Levetiracetam, you must tell the doctor about your medical history to check for unwanted effects.

• Pregnancy and Breastfeeding - Levetiracetam may affect the baby and cause side effects like cleft palate, bone defects, heart defects in the fetus, and urinary tract defects. Having seizures during pregnancy can injure the baby and increase the risk of miscarriage or stillbirth. The high levels of Levetiracetam in breast milk can cause sedation and other adverse effects.

• Allergies - Avoid taking Levetiracetam if you are allergic to Levetiracetam or its ingredients. It may cause severe allergic reactions like angioedema or anaphylaxis.

• Driving or Other Alert Tasks - Levetiracetam may cause drowsiness or dizziness, and it is advised to avoid driving or operating machinery while taking this medication.

• Kidney Disease - Levetiracetam is eliminated unchanged by the kidney. There is incomplete clearance of Levetiracetam in patients with renal disease.

• Blood Pressure - Levetiracetam may cause low blood pressure and bradycardia in patients with heart problems.

• Children - The drug is cautiously administered as it can increase side effects like aggression, agitation, anger, or depression.

What Are the Side Effects of Levetiracetam?

The most common side effects of Levetiracetam include

• Dizziness.

• Drowsiness.

• Tiredness.

• Weakness.

• Feeling aggressive or irritable.

• Loss of appetite.

• Stuffy nose.

• Infection.

• Unusual bleeding.

• Fever.

• Chills.

Serious side effects may include;

• Hallucinations.

• Confusion.

• Loss of balance or coordination.

• Easily bruising.

• Unusual change in mood or behavior.

• Skin rash.

IMPORTANT: The side effects above are not the only effects you will experience. In addition, there can be various other side effects. Call your doctor immediately if you experience any of the side effects listed above or discomfort. Also, always let your doctor know if you notice any unusual symptoms.

What Are the Interactions of Levetiracetam?

Interaction With Medicines:

• Antidepressants such as Escitalopram and Fluoxetine.

• Monoamine oxidase inhibitors like Isocarboxazid, Selegiline, or Tranylcypromine.

• Antiepileptics like Carbamazepine and Phenytoin.

• Benzodiazepines like Diazepam, Oxazepam, and Temazepam.

• Opioids like Methadone, Oxycodone, Morphine, or Codeine.

• Sedatives.

• Metoclopramide.

• Minocycline.

• Brivaracetam.

• Clozapine.

Interaction With Alcohol:

• Alcohol - Alcohol can increase the side effects of alcohol, such as dizziness, drowsiness, and difficulty concentrating. In addition, it can impair thinking and judgments; therefore, alcohol should be avoided while being treated with Levetiracetam.

Interactions With Disease:

• Suicidal Tendency - There is an increased risk of suicidal thoughts and behavior in patients taking Levetiracetam. Thus, it is contraindicated in people with depression or other psychiatric disorders and suicidal ideation, as it may further worsen the risk of suicidal thoughts.

• Hemodialysis - Levetiracetam is removed during hemodialysis. Hence it is advised to supplement the dose following dialysis.

• Renal Dysfunction - The clearance of Levetiracetam from the kidney is decreased in patients with renal impairment and should be administered cautiously at reduced dosages.

• Hematologic Abnormalities - Levetiracetam decreases blood count, hemoglobin, and hematocrit. It should be cautiously administered in patients with or predisposed to anemia or neutropenia.

What Are the Other Brand Names of Levetiracetam?

1. Tablet Levipil 500 mg.

2. Tablet Levitan injection.

3. Tablet Leveson SR 500 mg.

4. Tablet Levikem 500 mg.

5. Tablet Levetag 500 mg.

6. Tablet Leveter 750 mg.

7. Tablet Kricetam 250 mg.

8. Tablet Levepsy XR 750 mg.

9. Tablet Kivotam 500 mg.

10. Tablet Levicip 500 mg.