levetiracetam
Table of Contents
levetiracetam (Keppra)
see also:
Introduction
- levetiracetam is a newer anticonvulsant with similar efficacy as phenytoin for status epilepticus but without the iv line incompatibility issues
- useful for:
- partial onset seizures (monotherapy)
- myoclonic seizures (as add on)
- primary generalized tonic-clonic seizures (as add on)
Use in status epilepticus
- (off-label use)
- iv 25mg/kg (usually 1g in adults) over 15 min
- alternatively, some use up to 60mg/kg or 4.5g at 2 to 5 mg/kg/minute
- although not well studied, appears to be as effective as phenytoin but without the iv line incompatibility issues but may not be as effective as sodium valproate (Epilim) as a 2nd line for status
Use in subarachnoid haemorrhage
- (off-label use)
- prophylaxis of seizures
- load: iv 20mg/kg (rounded to nearest 250mg in adults) over 60 min
- maintenance: iv 1g over 15min every 12hrs for 7 days
Adult dosing and administration
- adjust dosing for renal impairment
iv administration
- when switching from oral dosing to iv dosing, daily dose should be the same
- usual initial maintenance dosing:
- iv 500mg twice daily
- may need to increase every 2 weeks by further 500mg/dose to max. of 1.5g bd
oral dosing
- immediate release tablets
- 500mg bd, may need to increase every 2 weeks by further 500mg/dose to max. of 1.5g bd
- extended release tablets
- initially 1g daily, increase every 2 weeks by further 1g/d as needed to max. 3g daily
Adverse effects
- increased BP
- behavioural issues, irritability
- headache
- drowsiness
- aggressive behaviour or psychotic issues (esp. children)
- vomiting
- nasal congestion, nasopharyngitis?
- eosinophilia (esp. children)
- neutropenia or agranulocytosis
- rarely, anaphylaxis or toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS)
- other rare effects
C/I and warnings
- pregnancy cat C
- lactation
- drug interactions
- renal impairment increases half life
P/K
- rapid and almost complete absorption following oral administration (100% bioavilability) with time to peak plasma concentration of around 1hr (4hrs for extended release tablets)
- Vd similar to water (0.5-0.7L/kg)
- less than 25% metabolised, mainly renal excretion with half life of 6-8hrs for adults and 4-7hrs for children
levetiracetam.txt · Last modified: 2018/12/21 02:27 by 127.0.0.1