Levetiracetam

Drug Information: Levetiracetam

Levetiracetam is a widely prescribed anticonvulsant medication used in the treatment of various seizure disorders. It is available in both oral and intravenous formulations, making it versatile for different clinical scenarios. Levetiracetam’s mechanism of action is primarily related to its binding to synaptic vesicle protein 2A (SV2A), which modulates neurotransmitter release and neuronal excitability. This unique mechanism contributes to its efficacy in controlling seizures while often exhibiting a favorable side effect profile compared to some older anticonvulsants.

Category

Neurological Drugs – Anticonvulsant

Mechanism of Action

Levetiracetam’s primary mechanism of action is believed to involve its binding to synaptic vesicle protein 2A (SV2A). SV2A is a transmembrane glycoprotein found on synaptic vesicles, which are responsible for storing and releasing neurotransmitters. While the precise functional consequences of SV2A binding are still under investigation, it is thought that levetiracetam modulates neurotransmitter release, specifically reducing the excessive neuronal excitability that underlies seizure activity. Specifically, Levetiracetam binding modulates the release of glutamate and GABA, helping to stabilize neuronal firing. It does not directly bind to GABA receptors, glutamate receptors, or voltage-gated ion channels, distinguishing it from many other anticonvulsant medications. By selectively binding to SV2A, levetiracetam likely fine-tunes synaptic transmission, preventing the hyperexcitability characteristic of seizures.

Clinical Uses

Levetiracetam is primarily used in the treatment of seizures. Its clinical applications include:

• Partial-Onset Seizures: As adjunctive therapy in adults and children 4 years of age and older with partial-onset seizures.
• Myoclonic Seizures: As adjunctive therapy in adults and adolescents 12 years of age and older with myoclonic seizures in juvenile myoclonic epilepsy.
• Generalized Tonic-Clonic Seizures: As adjunctive therapy in adults and children 6 years of age and older with primary generalized tonic-clonic seizures.

Beyond these primary indications, levetiracetam may be used off-label for other neurological conditions where seizure control or neuronal stabilization is desired, such as certain types of migraines or movement disorders. However, these uses are not as well-established and should be considered under the guidance of a qualified physician.

Dosage

Adults: The typical starting dose is 500 mg twice daily. This may be increased by 500 mg twice daily every 2 weeks, up to a maximum dose of 3000 mg per day, divided into two doses.

Pediatrics (4-16 years): The typical starting dose is 10 mg/kg twice daily. This may be increased by 10 mg/kg twice daily every 2 weeks, up to a maximum dose of 60 mg/kg per day, divided into two doses. It’s crucial to individualize the dose based on renal function and seizure control.

Route of Administration: Oral (tablets, solution) or intravenous (IV). The IV formulation is used when oral administration is not feasible.

Indications

Common indications for Levetiracetam include:

• Epilepsy (Partial-onset, Myoclonic, and Generalized Tonic-Clonic Seizures)
• Seizure prophylaxis in specific clinical situations

Contraindications

Levetiracetam is generally well-tolerated, but contraindications include:

• Known hypersensitivity to levetiracetam or any of its ingredients.

Caution should be exercised in patients with pre-existing renal impairment, and dosage adjustments may be necessary.

FAQ

Q: What are the common side effects of Levetiracetam?

A: Common side effects include somnolence (drowsiness), headache, dizziness, and asthenia (weakness). Some patients may also experience behavioral changes, particularly in children.

Q: How should I take Levetiracetam?

A: Levetiracetam can be taken with or without food. It’s important to take it at the same time(s) each day to maintain consistent blood levels.

Q: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up.

Q: Can I drink alcohol while taking Levetiracetam?

A: It’s generally recommended to avoid or limit alcohol consumption while taking Levetiracetam, as alcohol can worsen some side effects, such as drowsiness and dizziness.

Q: Does Levetiracetam interact with other medications?

A: Levetiracetam has relatively few drug interactions compared to some other anticonvulsants. However, it’s still important to inform your doctor about all medications you are taking, including over-the-counter drugs and supplements.

Q: How long does it take for Levetiracetam to start working?

A: Levetiracetam typically reaches steady-state concentrations in the blood within about 2 days. However, it may take several weeks to months to determine the optimal dose for seizure control.

Q: Is Levetiracetam safe during pregnancy?

A: The safety of Levetiracetam during pregnancy is not fully established. It should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Discuss the risks and benefits with your doctor.

Q: Can Levetiracetam cause behavioral problems?

A: Yes, in some individuals, Levetiracetam can be associated with behavioral changes such as irritability, aggression, anxiety, and depression. These are more commonly reported in children. If you experience significant behavioral changes, contact your doctor.