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Levetiracetam: Brands, Price & Uses in Bangladesh
Levetiracetam is a broad-spectrum antiepileptic drug used in the treatment of several seizure types, either alone or together with other antiseizure medicines.
About Levetiracetam
Indications of Levetiracetam
Levetiracetam is a broad-spectrum antiepileptic drug used in the treatment of several seizure types, either alone or together with other antiseizure medicines. Indications are classified below by strength of evidence.
Established / Approved Uses
- Partial-onset (focal) seizures - as monotherapy in adults and adolescents 16 years and older, and as adjunctive (add-on) therapy in patients 1 month of age and older.
- Myoclonic seizures in patients with juvenile myoclonic epilepsy - as adjunctive therapy in patients 12 years and older.
- Primary generalized tonic-clonic seizures in patients with idiopathic generalized epilepsy - as adjunctive therapy in patients 6 years and older.
Off-Label / Commonly Used (not formally FDA-approved for these uses)
- Management of status epilepticus (as an alternative to phenytoin/fosphenytoin or valproate, per some emergency protocols), usually by IV route.
- Seizure prophylaxis in selected neurosurgical or traumatic brain injury settings.
The decision to use Levetiracetam for a particular seizure type should be individualized by a treating physician based on seizure classification and patient factors.
Dosage & Administration of Levetiracetam
Dosing by Indication
| Indication | Population | Dosing |
|---|---|---|
| Partial-onset seizures (monotherapy) | Adults & adolescents ≥16 years | Start 500 mg twice daily; may increase every 2 weeks by 500 mg twice daily to a maximum of 1500 mg twice daily |
| Partial-onset seizures (adjunctive) | Adults | Start 500 mg twice daily; increase by 500 mg twice daily every 2 weeks as needed, maximum 1500 mg twice daily |
| Partial-onset seizures (adjunctive) | Children 1 month - <16 years | Weight-based dosing starting at 7-10 mg/kg twice daily, titrated gradually to a maximum of 21-30 mg/kg twice daily depending on age; a physician/pediatric neurologist must individualize this |
| Myoclonic seizures (adjunctive) | Patients ≥12 years | Start 500 mg twice daily; may increase by 500 mg twice daily every 2 weeks up to 1500 mg twice daily |
| Primary generalized tonic-clonic seizures (adjunctive) | Patients ≥6 years (weight-based in children) | Similar titration schedule as above, individualized by weight in children |
Renal Impairment (Adults)
| Creatinine Clearance | Dose |
|---|---|
| >80 mL/min | 500-1500 mg every 12 hours |
| 50-79 mL/min | 500-1000 mg every 12 hours |
| 30-49 mL/min | 250-750 mg every 12 hours |
| <30 mL/min | 250-500 mg every 12 hours |
| Hemodialysis patients | 500-1000 mg once daily, plus a supplemental dose of 250-500 mg after each dialysis session |
Levetiracetam must never be stopped abruptly (see Precautions). All doses above should be adjusted or confirmed by the prescribing physician.
Side Effects of Levetiracetam
Common Side Effects
| Population | Common Adverse Effects |
|---|---|
| Adults | Somnolence, asthenia (weakness/fatigue), infection, dizziness, headache, irritability |
| Children | Fatigue, aggression, nasal congestion, decreased appetite, irritability, behavioral changes |
Serious but Less Common Effects
- Behavioral/psychiatric symptoms - aggression, agitation, anxiety, depression, mood changes, and rare suicidal ideation (see Precautions)
- Severe skin reactions - Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS)
- Anaphylaxis and angioedema
- Blood cell abnormalities - decreased white blood cell/neutrophil counts
- Coordination difficulties, unsteady gait
Patients should seek prompt medical attention for any rash, swelling, breathing difficulty, or unusual bleeding/bruising.
Contraindications of Levetiracetam
Levetiracetam is contraindicated in patients with known hypersensitivity to levetiracetam, to other pyrrolidone derivatives, or to any excipient in the formulation. Hypersensitivity reactions including anaphylaxis and angioedema have been reported.
Frequently Asked Questions about Levetiracetam
What is Levetiracetam used for?
Levetiracetam is an antiepileptic (anticonvulsant) medicine used to treat certain types of seizures, including partial-onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures, either alone or together with other antiseizure medicines.
Can I stop taking Levetiracetam suddenly if I feel better?
No. Levetiracetam should never be stopped abruptly, as doing so can cause seizures to return more frequently or trigger a dangerous prolonged seizure (status epilepticus). Any dose change must be done gradually and only under a physician's guidance.
Does Levetiracetam cause mood or behavior changes?
Yes, behavioral and psychiatric side effects such as irritability, aggression, agitation, depression, and rarely suicidal thoughts have been reported with Levetiracetam, particularly in children. Patients and caregivers should watch for new or worsening mood or behavior changes and report them to a physician promptly, especially early in treatment.
Is Levetiracetam safe during pregnancy?
Levetiracetam should be used in pregnancy only if clearly needed, with the decision made together with a physician, since a small risk to the fetus cannot be completely excluded. However, available pregnancy registry data on Levetiracetam have not shown a substantially increased risk of major birth defects, and it is one of the more commonly used antiepileptic drugs in pregnancy. Uncontrolled seizures also pose risks, so treatment is usually continued under close medical supervision rather than stopped.
Do I need a lower dose of Levetiracetam if I have kidney problems?
Yes. Because Levetiracetam is eliminated mainly by the kidneys, patients with reduced kidney function need a lower dose or longer interval between doses, and patients on hemodialysis need a supplemental dose after each dialysis session. Your physician will adjust the dose based on your kidney function.
What should I do if I miss a dose of Levetiracetam?
Take the missed dose as soon as you remember, unless it is almost time for your next dose - in that case, skip the missed dose and continue your regular schedule. Do not take a double dose. Missing doses of Levetiracetam can increase the risk of breakthrough seizures, so try to take it consistently as prescribed.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.