Levetiracetam has a broad efficacy profile and can be useful in multiple seizure types (focal, generalised, myoclonic).
Overall, side-effect profile is good, with minimal drug interactions.
PBS indication (as of 1st January 2021) is:
- The condition must have failed to be controlled satisfactorily by other anti-epileptic drugs; OR
- Patient must be a woman of childbearing potential,
- The treatment must not be given concomitantly with brivaracetam, except for cross titration.
Notable side effects
- Drowsiness or somnolence.
- Disturbed behaviour, agitation or emotional lability, or mood changes can occur. Aggressiveness may be as frequent as 1 in 5.
- Drug withdrawal must be strongly considered if suicidal ideation occurs.
- Rash is uncommon.
- Rarely, a neutropenia, thrombocytopenia or liver dysfunction may occur.
- All anticonvulsants are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
For a complete list of adverse effects, appropriate formularies should be consulted.
- The initiation and escalation dose depends upon age, weight, syndrome, seizure frequency and intensity, and side effect profile.
- Unfortunately, a one-dose regime does not fit all.
- A Paediatric Neurologist should be consulted if there is uncertainty.
- Using intravenous formulation, levetiracetam can be used in emergency situations, e.g. status epilepsy. A similar dosage is used for intravenous administration if the patient is already on oral levetiracetam.
Commonly used regime
- Target dose 20-40mg/kg/day in two divided doses. Higher doses may be used (for example up to 60mg/kg).
- Start 10-20mg/kg/day in two divided doses, increasing each 2 weeks by 10mg/kg/day.
- Dosages per kilogram can only be used in children of weight approximately up to 30-40kgs.
- Recommended maximum adult dosage: 1.5 grams bd.
- Consult appropriate formularies for children with higher weights and in the adult range.
- These dosages are only a guide and appropriate formularies should be consulted as needed and tailored to the patient by the primary physician.
- Oral solution 100mg/ml or Tablet 250mg, 500mg, 1,000mg.
- There is an intravenous form.
- No drug level monitoring is currently available.
Interactions | Precautions
There are minimal drug interactions.