Definition
Levetiracetam is an anti-epileptic drug (AED). It is often used in combination with other medications in the treatment of epilepsy, a neurological dysfunction in which excessive surges of electrical energy are emitted in the brain.
Purpose
While levetiracetam controls the partial seizures (focal seizures) associated with epilepsy, there is no known cure for the disorder. In partial epileptic seizures, neural disturbances are limited to a specific region of the brain and the affected person usually remains conscious throughout the seizure. Although the precise mechanisms by which it works are unknown, levetiracetam is thought to exert its therapeutic effect by decreasing the abnormal activity and excitement within the area brain that may trigger partial seizures.
Research indicates that levetiracetam may also be effective in treating neurogenic pain.
Description
In the United States, levetiracetam is sold under the brand name Keppra. A newer generation medication, levetiracetam lacks many of the usual side effects commonly assoicated with other AEDs. Levetiracetam has fewer negative interactions with other AEDs or anti-convulsants, and may be used in combination with other AEDs in the treatment of epilepsy.
Recommended dosage
Levetiracetam is taken by mouth in tablet form. It is available in 250 mg, 500 mg, and 750 mg tablets. Levetiracetam is prescribed by physicians in varying total daily dosages, usually from 1000 mg to 3000 mg. Patients typically take divided doses (equal to one half of the total daily dose) twice daily.
Like many other AEDs, beginning a course of treatment which includes levetiracetam requires a gradual dose-increasing regimen. Adults and teenagers 16 years or older typically take 1000 mg a day for the first two weeks. Daily dosages of levetiracetam may then be increased by as much as 1000 mg every two weeks until reaching the maximum therapeutic dose (usually not more than 3000 mg). It may take several weeks to realize the full benefits of levetiracetam.
It is important not to take a double dose of levetiracetam. If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, then the missed dose should be skipped.
When ending treatment of AEDs, including levetiracetam, physicians typically direct patients to gradually reduce their daily dosages over a period of several weeks. Stopping the medicine suddenly may cause seizures to return or occur more frequently.
Precautions
A physician should be consulted before taking levetiracetam with certain non-perscription medications. Patients should avoid alcohol and CNS depressants (medications that make one drowsy or tired, such as anti-histimines, sleep medications, and some pain medications) while taking levetiracetam. It can exacerbate the side effects of alcohol and other medications.
Levetiracetam may not be suitable for persons with a history of kidney disease, depressed renal function, or mental illness.
Before beginning treatment with levetiracetam, patients should notify their physician if they consume a large amount of alcohol, have a history of drug use, are pregnant, or plan to become pregnant. Levetiracetam's safety during pregnancy has not been established. Patients taking levetiracetam with other AEDs or anti-convulsants should be aware that many AEDs and anti-convulsants have been shown to cause birth defects in animals. Patients who become pregnant while taking any AED or anti-convulsants should contact their physician immediately.
Side effects
Research indicates that levetiracetam is generally well tolerated and lacks many of the traditional side effects associated with AEDs. However, levetiracetam may case a variety of usually mild side effects in some patients. Cough, dizziness, and muscle weakness are the most frequently reported side effects of levetiracetam. Other possible side effects that do not usually require medical attention include:
- dryness or soreness of throat
- fever
- hoarseness or voice changes
- sleepiness or unusual drowsiness
- tender, swollen glands in neck
- numbness, prickling, "pins and needles," or tingling feelings
- loss of appetite or weight loss
Many of these side effects disappear or occur less frequently during treatment as the body adjusts to the medication. However, if any symptoms persist or become too uncomfortable, consult the prescribing physician.
Other, uncommon side effects of levetiracetam can indicate a potentially serious condition. A patient taking levetiracetam who experiencs any of the following symptoms should immediately contact their physician:
- clumsiness or unsteadiness
- depression, paranoia, or other significant mood changes
- double vision
- problems with memory
- lower back or side pain
- painful or difficult urination
- shortness of breath, wheezing, or troubled breathing.
Interactions
Levetiracetam is often used with other other seizure prevention medications, as prescribed by a physician. Unlike many other AEDs and anti-convulsants, levetiracetam does not decrease the effectiveness of oral contraceptives (birth control pills).
Resources
BOOKS
Weaver, Donald F. Epilepsy and Seizures: Everything You Need to Know. Firefly Books, 2001.
PERIODICALS
Hadjikoutis, S., et. al. "Weight loss associated with levetiracetam." British Medical Journal 327, no. 7420 (October 18, 2003): 905.
Shorvon, S. D., and K. van Rijckevorsel. "A new antiepileptic drug: levetiracetam, a pyrrolidone recently licensed as an antiepileptic drug." Journal of Neurology, Neurosurgery and Psychiatry 72, no. 4 (April 2002): 426.
OTHER
"Levetiracetam (Systemic)." Medline Plus. National Library of Medicine. (April 20, 2004). http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500101.html
ORGANIZATIONS
Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223, USA. (800) 332-1000. http://www.epilepsyfoundation.org.
American Epilepsy Society. 342 North Main Street, West Hartford, CT 06117-2507, USA. http://www.aesnet.org.
Adrienne Wilmoth Lerner
