Levetiracetam

Indications
 Oral
Adjunct in partial seizures
Adult: Initially, 500 mg bid on the 1st day. May increase in steps of 1 g at 2-4 wk intervals until effective antiepileptic control is achieved. Max: 3 g/day.
Child: 4-15 yr (<50 kg): Initially 10 mg/kg bid. May be increased by 10 mg/kg bid at 2-wk intervals. Adolescents ≥16 yr or 50 kg initially 500 mg bid. May be increased by 500 mg bid at 2-4 wk intervals. Max: 60 mg/kg/day.
Renal impairment: Suitable total daily dose (given as 2 divided doses) based on CrCl.
CrCl (ml/min)Dosage Recommendation
50-791-2 g
30-49500 mg - 1.5 g
<30500 mg - 1 g

Oral
Monotherapy for partial seizures with or without secondary generalisation
Adult: Initially 500 mg daily, increased after 2 wk to 1 g daily. May further increase in steps of 500 mg at 2 wk intervals. Max: 3 g/day.
Renal impairment: Suitable total daily dose (given as 2 divided doses) based on CrCl.
CrCl (ml/min)Dosage Recommendation
50-791-2 g
30-49500 mg - 1.5 g
<30500 mg -1 g

Intravenous
Adjunct in partial seizures
Adult: Initially, 500 mg bid on the 1st day. May increase in steps of 1 g at 2-4 wk intervals until effective antiepileptic control is achieved. Max: 3 g/day. No safety and efficacy data for IV usage >4 days.
Child: 4-15 yr (<50 kg): Initially 10 mg/kg bid via IV infusion over 15 min. May be increased by 10 mg/kg bid at 2-wk intervals. Adolescents ≥16 yr or 50 kg initially 500mg bid via IV infusion over 15 min. May be increased by 500 mg bid at 2-4 wk intervals. Max: 60 mg/kg/day.
Renal impairment: Suitable total daily dose (given as 2 divided doses) based on CrCl.
CrCl (ml/min)Dosage Recommendation
50-791-2 g
30-49500 mg - 1.5 g
<30500 mg - 1 g

Intravenous
Monotherapy for partial seizures with or without secondary generalisation
Adult: Initially 500 mg daily, increased after 2 wk to 1 g daily. May further increase in steps of 500 mg at 2 wk intervals. Max: 3 g/day. No safety and efficacy data for IV usage >4 days.
Renal impairment: Suitable total daily dose (given as 2 divided doses) based on CrCl.
CrCl (ml/min)Dosage Recommendation
50-791 - 2 g
30-50500 mg - 1.5 g
<30500 mg - 1 g


Special Populations: Severe renal impairment (<30 mL/min): 250-500 mg bid. End-stage renal failure patients using dialysis: 500-1000 mg every 24 hr; a supplemental dose of 250-500 mg following dialysis is recommended.

Reconstitution: Add 100 ml of suitable diluent to vial. Suitable diluents include sodium chloride (0.9%) injection; lactated Ringer's injection and dextrose 5% injection.
Warnings / Precautions
 Renal and hepatic impairment; pregnancy, lactation; patients undergoing haemodialysis. If psychotic symptoms (eg hallucination) and behavioural symptoms (eg agitation, anxiety) occur, reduce dosage. Abrupt withdrawal may result in increased seizure frequency. May impair ability to drive or operate machinery during initial therapy.
Adverse Reactions
 Somnolence, asthenia, dizziness, vertigo, depression, emotional instability, hostility, nervousness, ataxia, tremor, amnesia, headache, nausea, dyspepsia, diarrhoea, anorexia, rash, diplopia.
Mechanism of Actions
 Anticonvulsant used in the treatment of partial seizures. The precise mechanism of anticonvulsant effect is unknown.
Onset: 1 hr
Absorption: Rapidly and almost completely absorbed from GI tract.
Distribution: Not significantly protein bound (<10%). Distributed in breast milk.
Metabolism: Not extensively metabolised (24% into inactive metabolite); primarily by enzymatic hydrolysis.
Excretion: Excreted in the urine as both unchanged drug (66%) and metabolites. Plasma half life of 6-8 hr.
Administration
 May be taken with or without food. (Oral soln should be diluted in a glass of water.)
Storage Conditions
 Intravenous: Once reconstituted store at 15-30°C and use within 24 hr.
ATC Classification
 N03AX14 - levetiracetam ; Belongs to the class of other antiepileptics.
Storage
 Intravenous: Once reconstituted store at 15-30°C and use within 24 hr.
Available As
  • Levetiracetam 100 mg
  • Levetiracetam 1000 mg
  • Levetiracetam 250 mg
  • Levetiracetam 500 mg
  • Levetiracetam 750 mg

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