Advanced searches left 3/3
Search only database of 7.4 mil and more summaries

Levetiracetam Dosage

Summarized by PlexPage
Last Updated: 22 October 2020

* If you want to update the article please login/register

General | Latest Info

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider or pharmacist first. Levetiracetam has no known severe or serious interactions with other drugs. Levetiracetam has mild interactions with at least 21 different drugs. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist about all products you use. Keep a list of all your medications with you, and share list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

5. Side effects

In deciding to use medicine, risks of taking medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, following should be consider: tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also, tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non - prescription products, read the label or package ingredients carefully. Appropriate studies have not been performed on the relationship of age to effects of levetiracetam oral solution, tablets, or tablets for suspension in children younger than 1 month of age or in children younger than 4 years of age and weighing less than 20 kilograms, and levetiracetam extend - release tablets in children younger than 12 years of age or. Safety and efficacy have not been established in these age groups. Appropriate studies performed to date have not demonstrated geriatric - specific problems that would limit the usefulness of levetiracetam in the elderly. However, elderly patients are more likely to have age - related kidney problems, which may require caution and adjustment in dose for patients receiving levetiracetam. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh potential benefits against potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. Following interactions have been selected on the basis of their potential significance and are not necessarily all - inclusive. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both medicines. Calcifediol Methotrexate Orlistat Using this medicine with any of the following medicines may cause increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both medicines. Carbamazepine Ginkgo certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional about use of your medicine with food, alcohol, or tobacco. The presence of other medical problems may affect use of this medicine.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Indications

Table 1: Dosing Adjustment Regimen for Adult Patients with Renal Impairment

GroupCreatinine Clearance (mL/min/1.73m 2 )Dosage (mg)Frequency
Normal> 80500 to 1,500Every 12 hours
Mild50 - 80500 to 1,000Every 12 hours
Moderate30 - 50250 to 750Every 12 hours
Severe< 30250 to 500Every 12 hours
ESRD patients using dialysis----500 to 1,000Every 24 hours

Levetiracetam is a novel, antiepileptic drug used in treatment of partial seizures, myoclonic seizures, and tonic - clonic seizures. In 2000, FDA approved use of oral formulation as adjunctive therapy for treatment of focal seizures, myoclonic seizure, and primary generalized seizures. Fda approved intravenous levetiracetam in 2006 for use in patients older than 15 years, as adjunctive anticonvulsant therapy when oral formulation is not tolerate. In Europe, it is approved for treatment of partial seizures as a single agent and as an add - on treatment for partial seizures, tonic - clonic seizures, and myoclonic seizures. It is chemically unrelated to other antiepileptic drugs. Its favorable safety profile, distinct mechanism of action, and fewer drug interactions make it an attractive therapeutic choice for treatment of seizures.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Children:

Epilepsy is a common psychological disorder in children and frequently presents significant challenges for treatment. Seizures are refractory in about a quarter of children and pediatric epilepsy often occurs in the context of mental retardation or significant behavioral problems. Children with refractory epilepsy may receive trials of several antiepileptic drugs without achieving adequate seizure control or acceptable tolerability. Despite the availability of number of AEDs that are approved for pediatric use, additional AEDs that are effective and well - tolerated in children are still in need. Levetiracetam was recently approved for use as add - on therapy in children with partial seizures and now provides another alternative in treatment of pediatric epilepsy. Lev is a broad - spectrum AED with a unique preclinical and pharmacological profile. In rodent studies, it demonstrate no activity in traditional acute seizure models but exhibit potent seizure protection in chronic epilepsy models, ie, in kindle animals and in genetic models of generalized epilepsy. It was also protective against seizures in rodent models of chemoconvulsant - inducing partial seizures. Lev exhibits antiepileptogenic properties through its ability to inhibit development of kindling in mice and rats and demonstrates high safety margin compared with other AEDs in genetic models and kindle animals. Molecular mechanisms through which LEV exerts its antiepileptic effects are not fully known but are unlike those of any other AED. Lev binds to a unique binding site in the brain, synaptic vesicle protein SV2A. The function of this protein is still under investigation, but current evidence suggests that it modulates synaptic vesicle fusion and consequent release of neurotransmitter into synapse. Because LEV does not appear to affect normal brain physiology, it is believed to modulate SV2A function only under pathophysiologic conditions. Lev is also known to selectively inhibit N - type calcium channels and to block inhibition of GABA - and glycine - gate currents by negative allosteric modulators. Whether LEVs binding to SV2A proteins mediate these mechanisms is unknown. Lev has been FDA approved since 1999 for adjunctive treatment of refractory partial seizures in adults and in 2005, that approval was extended to include children 4 years old. Most recently, approval was further broadened to include adjunctive treatment of myoclonic seizures in adults and adolescents 12 years of age with juvenile myoclonic epilepsy and adjunctive treatment of primary generalized tonic - clonic seizures in adults and children 6 years of age with idiopathic generalized epilepsy. Emea indications are similar, except that the age range approved for PGTC seizures is 12 years, and LEV is also approved as monotherapy in adults with newly diagnosed partial seizures. Lev, as add - on therapy, has also demonstrated efficacy for refractory idiopathic generalized epilepsies in open - label trials that include adult patients with myoclonic, tonic - clonic, and absence seizures. Although the efficacy, safety, and tolerability profile of LEV is well established in treatment of adult epilepsy patients, data in children is somewhat limited. This article reviews available published data on LEV in treatment of pediatric epilepsy, including pertinent information on LEV pharmacokinetics, formulations, efficacy, and safety.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Neonatal Seizures (Orphan)

Traditionally, preferred agent for treatment of neonatal seizures has been phenobarbital, followed by phenytoin or fosphenytoin, and then benzodiazepines. Evidence for treatment with these agents was extrapolated from data in adults and children. However, it is evident these therapies alone are not adequate to control neonatal seizures. Painter et al 16 report phenobarbital and phenytoin relieved seizures in only 43% and 45% of neonates, respectively, when used as primary agent and up to 62% of the time in combined therapy. Authors find that severity and progression of seizures were better predictors of successful treatment rather than AED use. 16 As stated above, phenobarbital is the preferred first - line agent in most neonatal seizures, compared to pediatrics and adults, where phenytoin use is more common. This preference is related to greater historical experience with phenobarbital, 17 and difficulties with phenytoin dosing and monitoring in neonatal population. Challenges with phenytoin dosing in this population include reduced protein binding compared to that in adults; competitive binding with bilirubin, endogenous corticosteroids, and free fatty acids, lower serum albumin concentrations compared to that in adults, and varying adipose tissue. 18 - 20 Additionally, due to incomplete maturation of CYP2C9 enzyme and saturable metabolism, phenytoin half - life is prolonged from 8 hours in patients older than 2 weeks to 20 hours in term infants and 75 hours in preterm neonates. 17 21 although dosage regimens for phenobarbital and benzodiazepines are less complex than those for phenytoin in the neonatal population, they may be less effective due to receptor and ion gradient variations in neonate described previously. 2. A Decrease response with benzodiazepines and phenobarbital may be expected as inhibitory GABA receptors target are underexpressed in the neonatal brain. Immature GABA receptors overexpress 4 subunits compared to 1, which has been shown to decrease responsiveness to benzodiazepine therapy. Consideration has to be given to reverse Cl gradient. Activation of GABA receptor in the mature brain allows for opening of Cl - selective pore, influx of Cl along its gradient, and hyperpolarization of cell.S However, in immature neonatal brain, GABA activation by agonist leads to efflux of Cl due to high intracellular concentrations, which may cause depolarization of membrane resulting in Neuronal firing. 6 these variations may be the reason for limited efficacy of phenobarbital and benzodiazepines observed in neonatal studies. There is concern regarding potential adverse effects traditional AEDs may have on neurodevelopment. Medications such as NMDA receptor antagonists I. E, ketamine, GABA agonists I. E, lorazepam or phenobarbital and sodium channel blockers I. E, phenytoin or carbamazepine have been observed to potentiate neurodegeneration in the developing brain in animal models. 22 Neuronal death by apoptosis is one possible mechanism explaining cognitive impairment and reduced brain mass in animals treated with these agents. Bittigau et al 23 studied the effects of multiple AEDs in animal models at relevant human doses.


TREATMENT

Treatment outcomes are disappointing and close interaction between doctors and families is mandatory. Early diagnosis is necessary in order to avoid antiepileptic drugs that can aggravate seizures, such as carbamazepine and lamotrigine. Valproate, benzodiazepines, stiripentol, and topiramate are the most useful AEDs. When an infant starts to present with long and repeated convulsive seizures before 1 year, continuous treatment is indicated even if diagnosis is not yet affirm, as well as rectal injection of benzodiazepine at time of seizure. Valproate is commonly used in France, but potassium bromide can allow good control of convulsive seizures and is largely used in Germany and Japan. When seizures cannot be controlled and tend to realize status, the most efficacious treatment is association of stiripentol, clobazam, and valproate. Stiripentol, new AED, is the only drug which has been proven to be efficacious in the majority of these patients by controlled trials. It has been approved by the European Medicines Agency and is progressively marketed in European countries. Topiramate can also be efficacious but its side - effects need to be carefully monitor: loss of weight, hyponatremia, slowing of language acquisitions. The benefit of a ketogenic diet has been demonstrated in several patients. Ethosuximide can be used for myoclonic and absence seizures and phenobarbital for convulsive seizures when other AEDs have fail. Levetiracetam seems promising for every seizure type. When children are photosensitive, use of special blue lens can suppress or decrease light - induced seizures, whereas pattern sensitivity is difficult to control. It is also important to avoid long, generalize, or unilateral seizures to prevent infectious diseases and hyperthermia, which are their triggering factors. In this epilepsy, no pharmacological treatment has ever been allowed to suppress epileptic seizures completely. So we should not give many AEDs together because they have a deleterious effect on behaviour and acquisitions. The aim of treatment should not be to make seizures disappear, but to decrease their number and duration while favoring good cognitive development. Management of statuses is still controversial, but use of rectal, buccal / nasal, or intravenous benzodiazepines is generally indicate, provided that dose remain reasonable. In same way, when benzodiazepines have failed to control seizures, and intravenous phenytoin and barbiturates are being consider, careful monitoring of plasma levels is required in order to avoid complications due to overdosing. Recently, anecdotic results have been obtained with intravenous levetiracetam but further studies are needed to evaluate its actual value. Repeat cognitive evaluations are recommended in order to understand better factors responsible for cognitive defects and the respective roles of seizures and AEDs. One must keep in mind that infants with Dravet syndrome are at risk of becoming a handicapped child, adolescent, and adult, and it is possible to decrease the degree of this handicap by offering him or her a good environment with appropriate educative and rehabilitative methods.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Pharmacology

The precise mechanism by which levetiracetam exerts its antiepileptic effect is unknown. Antiepileptic activity of levetiracetam was assessed in a number of animal models of epileptic seizures. Levetiracetam does not inhibit single seizures induced by maximal stimulation with electrical current or different chemoconvulsants and shows only minimal activity in submaximal stimulation and in threshold tests. Protection was observe, however, against secondarily generalized activity from focal seizures induced by pilocarpine and kainic acid, two chemoconvulsants that induce seizures that mimic some features of human complex partial seizures with secondary generalization. Levetiracetam also displays inhibitory properties in kindling model in rats, another model of human complex partial seizures, both during kindling development and in fully kindle state. The predictive value of these animal models for specific types of human epilepsy is uncertain. In vitro and in vivo recordings of epileptiform activity from hippocampus have shown that levetiracetam inhibits burst firing without affecting normal neuronal excitability, suggesting that levetiracetam may selectively prevent hypersynchronization of epileptiform burst firing and propagation of seizure activity. Levetiracetam at concentrations of up to 10 M does not demonstrate binding affinity for a variety of known receptors, such as those associated with benzodiazepines, GABA, glycine, NMDA, re - uptake sites, and second messenger systems. Furthermore, in vitro studies have failed to find effect of levetiracetam on neuronal voltage - gated sodium or T - type calcium currents and levetiracetam does not appear to directly facilitate GABAergic neurotransmission. However, in vitro studies have demonstrated that levetiracetam opposes activity of negative modulators of GABA - and glycine - gate currents and partially inhibits N - type calcium currents in neuronal cells. Saturable and stereoselective neuronal binding sites in rat brain tissue have been described for levetiracetam. Experimental data indicate that this binding site is synaptic vesicle protein SV2A, thought to be involved in regulation of vesicle exocytosis. Although the molecular significance of levetiracetam binding to SV2A is not understood, levetiracetam and related analogs show rank order of affinity for SV2A which correlates with the potency of their antiseizure activity in audiogenic seizure - prone mice. These findings suggest that interaction of levetiracetam with SV2A protein may contribute to antiepileptic mechanism of action of drug.


Levetiracetam for Veterinary Use

Levetiracetam is an antiepileptic medication that has fewer cutaneous reactions as compared to other antiepileptics. The case was reported of a 64 - year - old man present with altered mental status and aphasia. Upon hospitalization, levetiracetam was given intravenously twice a day, for seizure prophylaxis. After 13 doses, diffuse, enormous warm, blanching, morbilliform rash developed. Levetiracetam was discontinue, methylprednisolone was started and the rash disappeared after 4 days. Only four other cases of skin reactions following levetiracetam administration have been reported in literature: two were classified as Stevens - Johnson Syndrome, one as toxic epidermal necrolysis and one as erythema multiforme. Naranjo's score of 7 indicates that levetiracetam therapy was the most likely cause of skin reaction. Lev is often used off - label in SE as urgent control agent. Lev has distinct mechanisms of action. In animal model, it was found to inhibit neuronal hypersynchronization in the hippocampus and development of electric kindling in the amygdala. The main target has been identified to be the SV2A receptor, membrane protein on all synaptic vesicles which modulates vesicle fusion. It is thought that LEV binding to this receptor enhances its function to inhibit abnormal epileptic bursts. In 18 patients with SE refractory to benzodiazepines, LEV was able to control SE in 16 subjects. The Loading dose of LEV is 20 mg / kg IV over 15 minutes. In a small retrospective chart review, LEV terminated SE in 69% of patients after they had failed at least one AED. No cardiac side - effects were see; only nausea and vomiting during loading. Renal function needs to be considered when choosing maintenance dosing as LEV is primarily clear through kidneys. Supplemental doses need to be given after dialysis. Lev is not metabolized by the liver, making it a good agent for patients with hepatic failure. Lev can be used in treatment of SRSE in acute intermittent porphyria. Lev does not succeed as add - on therapy to benzodiazepines for out - of - hospital treatment of GCSE.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

logo

Plex.page is an Online Knowledge, where all the summarized are written by a machine. We aim to collect all the knowledge the World Wide Web has to offer.

Partners:
Nvidia inception logo
jooble logo

© All rights reserved
2021 made by Algoritmi Vision Inc.

If your domain is listed as one of the sources on any summary, you can consider participating in the "Online Knowledge" program, if you want to proceed, please follow these instructions to apply.
However, if you still want us to remove all links leading to your domain from Plex.page and never use your website as a source, please follow these instructions.