(June 22, 2023)
Adult dose for status epilepticus (7, 12)
Pediatric dose for status epilepticus (12, 13, 14)
US FDA-Labeled (21)
Advantages of levetiracetam in the ED
LEV has a long-standing clinical experience in adults and children, with a straightforward pharmacokinetic profile (1, 20):
Levetiracetam and TBI seizure prophylaxis new!
Post-traumatic seizures (PTS)
Studies have used different dosing of LEV for PTS prophylaxis. A 2022 study compared different dosing strategies and did not find a significant difference in the cumulative incidence of early PTS between dosing strategies (≤1000 mg/day, 1500 mg/day, and ≥2000 mg/day)(22).
Most experts recommend a dosing range of 500 to 1000 mg every 12 hours if no seizure activity has been detected.
No contraindications besides known hypersensitivity, allergy or anaphylaxis to LEV.
Warnings and significant adverse effects (21)
Most common adverse effects that lead to discontinuation of therapy are somnolence (11-15%) and fatigue (10-11%).
Coordination Difficulties: Monitor for ataxia (3%), abnormal gait, and incoordination.
Behavioral abnormalities including psychotic symptoms, suicidal ideation (1%), irritability, depression (2-5%) and aggressive behavior have been observed; monitor patients for psychiatric signs and symptoms.
Abrupt cessation of LEV in a long term user can precipitate seizures.
Major drug interactions (21)
In vitro data on metabolic interactions indicate that levetiracetam is unlikely to produce, or be subject to, pharmacokinetic interactions. Levetiracetam and its major metabolite, at concentrations well above Cmax levels achieved within the therapeutic dose range, are neither inhibitors of, nor high affinity substrates for, human liver cytochrome P450 isoforms, epoxide hydrolase or UDP-glucuronidation enzymes (21).
Monitor concomitant usage of other central nervous system depressants, as it thought it could lead to oversedation in a LEV user.
van Rijckevorsel K, Boon PA. The 'number needed to treat' with Levetiracetam (LEV): comparison with the other new antiepileptic drugs (AEDs). Seizure. 2001;10(3):235-236. doi:10.1053/seiz.2001.0497