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Keppra
levetiracetam
Adult Dosing .
Dosage forms: TAB: 250 mg, 500 mg, 750 mg, 1000 mg; SOLUTION: 100 mg per mL; INJ: various
partial seizures
- [500-1500 mg PO/IV q12h]
- Start: 500 mg PO/IV q12h, may incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: dose adjustment may be needed during pregnancy and/or postpartum; do not cut/crush/chew tab; taper dose gradually to D/C
juvenile myoclonic epilepsy, adjunct tx
- [1500 mg PO/IV q12h]
- Start: 500 mg PO/IV q12h, incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: dose adjustment may be needed during pregnancy and/or postpartum; do not cut/crush/chew tab; taper dose gradually to D/C
primary generalized tonic clonic seizures, adjunct tx
- [1500 mg PO/IV q12h]
- Start: 500 mg PO/IV q12h, incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: dose adjustment may be needed during pregnancy and/or postpartum; do not cut/crush/chew tab; taper dose gradually to D/C
status epilepticus (off-label)
- [60 mg/kg/dose IV x1]
- Max: 4500 mg/dose
cyclic vomiting syndrome prophylaxis, moderate-severe (off-label)
- [1000-2000 mg/day PO in divided doses]
- Start: 250 mg PO bid, incr. by 500 mg/day q2wk; Info: dose adjustment may be needed during pregnancy and/or postpartum; do not cut/crush/chew tab; taper dose gradually to D/C
renal dosing
- [status epilepticus]
- renal impairment: not defined
- HD/PD: not defined
- [moderate-severe cyclic vomiting syndrome prophylaxis]
- renal impairment: decr. usual dose, amount not defined
- HD/PD: not defined
- [all other indications]
- CrCl 50-80: 500-1000 mg q12h; CrCl 30-50: 250-750 mg q12h; CrCl <30: 250-500 mg q12h
- HD: 500-1000 mg q24h; give 250-500 mg as supplement after dialysis; PD: 500-1000 mg q24h; no supplement
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: TAB: 250 mg, 500 mg, 750 mg, 1000 mg; SOLUTION: 100 mg per mL; INJ: various
partial seizures
- [oral solution or IV form, 1-5 mo]
- Dose: 42 mg/kg/day PO/IV divided q12h; Start: 14 mg/kg/day PO/IV divided q12h, incr. by 14 mg/kg/day q2wk; Info: taper dose gradually to D/C
- [oral solution or IV form, 6 mo-3 yo]
- Dose: 50 mg/kg/day PO/IV divided q12h; Start: 20 mg/kg/day PO/IV divided q12h, incr. by 20 mg/kg/day q2wk; Info: taper dose gradually to D/C
- [oral solution or IV form, 4-15 yo]
- Dose: 60 mg/kg/day PO/IV divided q12h; Start: 20 mg/kg/day PO/IV divided q12h, incr. by 20 mg/kg/day q2wk; Max: 3000 mg/day; Info: taper dose gradually to D/C
- [oral solution or IV form, 16 yo and older]
- Dose: 500-1500 mg PO/IV q12h; Start: 500 mg PO/IV q12h, may incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: taper dose gradually to D/C
- [oral tab, 4-15 yo, 20-40 kg]
- Dose: 750 mg PO q12h; Start: 250 mg PO q12h x2wk, then incr. by 500 mg/day q2wk; Max: 1500 mg/day; Info: do not cut/crush/chew tab; taper dose gradually to D/C
- [oral tab, 4-15 yo, >40 kg]
- Dose: 1500 mg PO q12h; Start: 500 mg PO q12h x2wk, then incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: do not cut/crush/chew tab; taper dose gradually to D/C
- [oral tab, 16 yo and older]
- Dose: 500-1500 mg PO q12h; Start: 500 mg PO q12h, may incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: do not cut/crush/chew tab; taper dose gradually to D/C
juvenile myoclonic epilepsy, adjunct tx
- [12 yo and older]
- Dose: 1500 mg PO/IV q12h; Start: 500 mg PO/IV q12h, incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: do not cut/crush/chew tab; taper dose gradually to D/C
primary generalized tonic clonic seizures, adjunct tx
- [6-15 yo]
- Dose: 60 mg/kg/day PO/IV divided q12h; Start: 20 mg/kg/day PO/IV divided q12h, incr. by 20 mg/kg/day q2wk; Max: 3000 mg/day; Info: do not cut/crush/chew tab; taper dose gradually to D/C
- [16 yo and older]
- Dose: 1500 mg PO/IV q12h; Start: 500 mg PO/IV q12h, incr. by 1000 mg/day q2wk; Max: 3000 mg/day; Info: do not cut/crush/chew tab; taper dose gradually to D/C
status epilepticus (off-label)
- [60 mg/kg/dose IV x1]
- Max: 4500 mg/dose
renal dosing
- [status epilepticus]
- renal impairment: not defined
- HD/PD: not defined
- [all other indications]
- CrCl <50: decr. usual dose by 50%
- HD: give 50% usual dose q24h; give supplement after dialysis, amount not defined; PD: give 50% usual dose q24h; no supplement
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- abrupt withdrawal
- caution: pregnancy
- caution: renal impairment
- caution: psychiatric disorder
Drug Interactions .
Overview
levetiracetam
SV2A inhibitor
- affected by altered fat absorption
- antiepileptic agent
- binds to anion exchange resin/polymer
- CNS depression
Contraindicated
- amifampridine
- bupropion
- dalfampridine
Avoid/Use Alternative
- butalbital
- clonidine
- codeine
- doxylamine
- ethanol (alcoholic beverage)
- ethanol injection
- ginkgo
- haloperidol
- hydrocodone
- isocarboxazid
- kava
- kratom
- metaxalone
- metoclopramide
- midazolam
- oxybate
- phenelzine
- promethazine
- ropeginterferon alfa-2b
- scopolamine
- thalidomide
- tradipitant
- tranylcypromine
- trimethobenzamide
- zuranolone
Monitor/Modify Tx
- aldesleukin
- alfentanil
- alprazolam
- baclofen intrathecal
- buprenorphine
- butorphanol
- carbamazepine
- chlordiazepoxide
- chlorpromazine
- clobazam
- clonazepam
- clorazepate
- daridorexant
- desflurane
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- dihydrocodeine
- droperidol
- esketamine
- estazolam
- eszopiclone
- ethanol (in some formulations)
- etomidate
- fentanyl
- fluphenazine
- flurazepam
- gabapentin
- gabapentin enacarbil
- hydromorphone
- hydroxyzine
- ifosfamide
- isoflurane
- ketamine
- lemborexant
- levorphanol
- lorazepam
- meperidine
- methadone
- methohexital
- mirtazapine
- morphine
- nalbuphine
- nelarabine
- olanzapine
- oliceridine
- opicapone
- opium
- oxazepam
- oxybutynin
- oxycodone
- oxymorphone
- pentazocine
- pentobarbital
- perphenazine
- phenobarbital
- pregabalin
- primidone
- propofol
- quazepam
- remifentanil
- remimazolam
- sevelamer
- sevoflurane
- sufentanil
- suvorexant
- tapentadol
- temazepam
- thioridazine
- thiothixene
- tramadol
- triazolam
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- acyclovir
- allopurinol
- almotriptan
- amantadine
- aminophylline
- amitriptyline
- amoxapine
- amoxicillin
- amphetamine
- ampicillin
- apalutamide
- apomorphine
- apraclonidine ophthalmic
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- axicabtagene ciloleucel
- baclofen
- benzphetamine
- betamethasone
- brexpiprazole
- brexucabtagene autoleucel
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- cannabis
- carbinoxamine
- cariprazine
- carisoprodol
- cefazolin
- cefepime
- cefiderocol
- ceftaroline
- ceftazidime
- ceftobiprole
- cenobamate
- cetirizine
- chamomile, German
- chlophedianol
- chlorambucil
- chlorcyclizine
- chloroquine
- chlorpheniramine
- chlorzoxazone
- ciltacabtagene autoleucel
- ciprofloxacin
- cisatracurium
- citalopram
- clemastine
- clomipramine
- clozapine
- cocaine
- cortisone
- cyclobenzaprine
- cycloserine
- cyclosporine
- cyproheptadine
- dantrolene
- darbepoetin alfa
- darifenacin
- darolutamide
- deflazacort
- delafloxacin
- desipramine
- desvenlafaxine
- deutetrabenazine
- dexamethasone
- dexbrompheniramine
- dexchlorpheniramine
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- dicloxacillin
- diethylpropion
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- domperidone
- donepezil
- doxepin
- doxepin topical
- dronabinol
- duloxetine
- efavirenz
- eletriptan
- elinzanetant
- elivaldogene autotemcel
- entacapone
- entrectinib
- enzalutamide
- ephedra
- epoetin alfa
- ertapenem
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fesoterodine
- flibanserin
- fluoxetine
- fluvoxamine
- foscarnet
- foslevodopa
- fosphenytoin
- frovatriptan
- galantamine
- ganaxolone
- ganciclovir
- glofitamab
- glycopyrrolate
- goserelin
- guanfacine
- histrelin
- hydroxychloroquine
- hyoscyamine
- idecabtagene vicleucel
- iloperidone
- imipenem
- imipramine
- interferon beta 1a
- interferon beta 1b
- iohexol
- iopamidol
- isoniazid
- ketorolac
- lacosamide
- lamotrigine
- leuprolide
- levocarnitine
- levocetirizine
- levodopa
- levofloxacin
- levomilnacipran
- lidocaine
- lidocaine topical
- linezolid
- linvoseltamab
- lisdexamfetamine
- lisocabtagene maraleucel
- lithium
- lofexidine
- lorlatinib
- loxapine
- lumateperone
- lurasidone
- magnesium citrate
- meclizine
- mefloquine
- melatonin
- meprobamate
- meropenem
- methamphetamine
- methocarbamol
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methsuximide
- methyldopa
- metronidazole
- metyrapone
- metyrosine
- mexiletine
- milnacipran
- milsaperidone
- mitotane
- molindone
- mosunetuzumab
- moxifloxacin
- mycophenolate mofetil
- nafarelin nasal
- nafcillin
- naltrexone
- naratriptan
- nefazodone
- nortriptyline
- obecabtagene autoleucel
- ofloxacin
- orphenadrine
- oxacillin
- oxcarbazepine
- paliperidone
- paroxetine
- passion flower
- peginterferon beta 1a
- penicillin G
- penicillin V
- perampanel
- phendimetrazine
- pheniramine
- phentermine
- phenytoin
- pimozide
- piperacillin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pramipexole
- procarbazine
- prochlorperazine
- protriptyline
- pyridostigmine
- pyrilamine
- pyrimethamine
- quetiapine
- quinine
- ramelteon
- rasagiline
- regadenoson
- repotrectinib
- risperidone
- rivastigmine
- rizatriptan
- ropinirole
- rotigotine transdermal
- rufinamide
- safinamide
- selegiline
- selegiline transdermal
- selinexor
- sertraline
- sodium picosulfate
- solifenacin
- stiripentol
- sulfate bowel prep
- sumatriptan
- tacrolimus
- tasimelteon
- teclistamab
- terbutaline
- tetrabenazine
- theophylline
- thiotepa
- tiagabine
- tinidazole
- tisagenlecleucel
- tizanidine
- tolcapone
- tolterodine
- topiramate
- tranexamic acid
- trazodone
- treosulfan
- triamcinolone
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- triptorelin
- trospium
- vadadustat
- valacyclovir
- valbenazine
- valerian
- valganciclovir
- valproic acid
- varenicline
- venlafaxine
- vigabatrin
- vilazodone
- viloxazine
- ziprasidone
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- depression
- hostility
- aggressive behavior
- psychosis
- suicidality
- leukopenia
- neutropenia
- pancytopenia
- agranulocytosis
- thrombocytopenia
- anaphylaxis
- angioedema
- drug reaction with eosinophilia and systemic symptoms
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- hyponatremia
- acute renal failure
- rhabdomyolysis
- withdrawal seizures if abrupt D/C
- seizure disorder exacerbation (patients with SCN8A mutation)
Common Reactions
- headache
- BP incr. (patients <4 yo)
- psychosis
- somnolence
- asthenia
- URI symptoms
- vomiting
- infection
- irritability
- fatigue
- aggressive behavior
- dizziness
- anorexia
- pain
- eosinophilia
- diarrhea
- emotional lability
- depression
- nausea
- vertigo
- insomnia
- agitation
- anxiety
- ataxia
- leukopenia
- neutropenia
- confusion
- constipation
- hostility
- amnesia
- diplopia
- paresthesia
- alopecia
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; BP in patients <4 yo; signs/symptoms of depression, behavior changes, suicidality
Look/Sound-Alike Drug Names
Keppra confused with: Kaletra; Keflex
levETIRAcetam confused with: lamoTRIgine; levOCARNitine; levoFLOXacin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; dose adjustment may be needed during pregnancy and/or postpartum; risk of teratogenicity not expected, though possible risk of intrauterine growth restriction based on limited human data; risk of minor fetal skeletal abnormalities and decr. fetal wt based on animal data; possible risk of decr. drug levels, efficacy in pregnant patients
Pregnancy Registry
encourage patients to enroll in North American Antiepileptic Drug Pregnancy Registry at 1-888-233-2334; additional info at www.aedpregnancyregistry.org
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no known risk of infant harm based on limited human data; inadequate human data available, though possible decr. milk production
Pharmacology .
Metabolism: for levetiracetam: hydrolysis minimally; CYP450: none
Excretion: for levetiracetam: urine primarily (66% unchanged); Half-life: 6-8h
Subclass: Seizure Disorders
Mechanism of Action
for levetiracetam: exact mechanism of action unknown; selectively prevents hypersynchronization of epileptiform burst firing
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: UCB Pharma, Inc.
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral solution:
- 100 mg/mL (120 mL): $207.00
oral tablet:
- 250 mg (60 ea): $428.00
- 500 mg (60 ea): $520.00
- 750 mg (120 ea): $1,394.00
- 1,000 mg (60 ea): $1,031.00
intravenous solution:
- 500 mg (1 vial, 5 mL): $63.00
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