General

Pronunciation
le-ve-teer-A-se-tam

Trade Name(s)

• Keppra

• Keppra XR

Pregnancy Category
Category C

Ther. class.
anticonvulsants

Pharm. class.
pyrrolidines

Indications

• Partial onset seizures (adjunct)

• Primary generalized tonic-clonic seizures (adjunct) (immediate-release and injection only)

• Myoclonic seizures in patients with juvenile myoclonic epilepsy (adjunct) (immediate-release and injection only)

Action

Appears to inhibit burst firing without affecting normal neuronal excitability and may selectively prevent hypersynchronization of epileptiform burst firing and propagation of seizure activity

Therapeutic Effect(s):
Decreased incidence and severity of seizures

Pharmacokinetics

Absorption: Rapidly and completely absorbed following oral administration

Distribution: Unknown

Metabolism and Excretion: 66% excreted unchanged by the kidneys; some metabolism by the liver (metabolites inactive)

Half-life: 7.1 hr (↑ in renal impairment)

TIME/ACTION PROFILE (blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1–1.5 hr†‡	12 hr

†1 hr in the fasting state, 1.5 hr when taken with food
‡ 4 hr with extended-release

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Lactation: Lactation

Use Cautiously in:

• All patients (may ↑ risk of suicidal thoughts/behaviors)

• Renal impairment (dose reduction recommended if CCr C80 mL/min)

• Pedi: Children <4 yr (safety not established); <16 yr (for extended-release and injection)

• OB: Use only during pregnancy if potential benefit justifies potential risk to fetus

• Geri: ↓ renal elimination (dose ↓ may be necessary)

Adverse Reactions/Side Effects

CNS: SUICIDAL THOUGHTS, dizziness, fatigue/somnolence, weakness, behavioral abnormalities.

Neuro: coordination difficulties (adults only).

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug
None noted

Route/Dosage

Partial Onset Seizures

• PO, IV (Adults and Children B16 yr): 500 mg 2 times daily initially; may be ↑ by 1000 mg/day at 2-wk intervals up to 3000 mg/day; Extended-release—1000 mg daily; may ↑ by 1000 mg/day at 2–wk intervals up to 3000 mg/day.

• PO (Children 4–15 yrs): 10 mg/kg twice daily; ↑ by 20 mg/kg/day at 2-wk intervals to recommended dose of 30 mg/kg twice daily.

Primary Generalized Tonic-Clonic Seizures

• PO, IV (Adults and Children B16 yr): 500 mg 2 times daily initially; ↑ by 1000 mg/day at 2-wk intervals to recommended dose of 3000 mg/day.

• PO (Children 6–15 yrs): 10 mg/kg twice daily; ↑ by 20 mg/kg/day at 2-wk intervals to recommended dose of 30 mg/kg 2 times daily.

Myoclonic Seizures

• IV (Adults and Children B16 yr): 500 mg 2 times daily initially; ↑ by 1000 mg/day at 2-wk intervals to recommended dose of 3000 mg/day.

• PO (Children B12 yrs): 500 mg twice daily initially; ↑ by 1000 mg/day at 2-wk intervals to recommended dose of 3000 mg/day.

Renal Impairment

• PO, IV (Adults): CCr 50–80 mL/min—500–1000 mg q 12 hr (1000–2000 mg q 24 hr for extended-release); CCr 30–50 mL/min—250–750 mg q 12 hr (500–1500 mg q 24 hr for extended-release); CCr <30 mL/min—250–500 mg q 12 hr (500–1000 mg q 24 hr for extended-release); Dialysis (immediate–release and injection)500–1000 mg q 24 hr with a 250–500–mg supplemental dose after dialysis.

Availability

• Tablets: 250 mg, 500 mg, 750 mg, 100 mg

» Cost: 250 mg $385.94/180, 500 mg $519.93/180, 750 mg $699.95/180, 1000 mg $1,021.30/180.

• Extended-release tablets: 500 mg, 750 mg

• Oral solution (grape-flavored): 100 mg/mL

» Cost: $282.43/480 mL.

• Injection: 100 mg/mL

Assessment

• Assess location, duration, and characteristics of seizure activity

• Assess patient for CNS adverse effects throughout therapy. These adverse effects are categorized as somnolence and fatigue (asthenia), coordination difficulties (ataxia, abnormal gait, or incoordination), and behavioral abnormalities (agitation, hostility, anxiety, apathy, emotional lability, depersonalization, depression) and usually occur during the first 4 wk of therapy

Lab Test Considerations

• May cause ↓ RBC and WBC and abnormal liver function tests

Potential Nursing Diagnoses

• Risk for injury (Side Effects)

Implementation

• Do not confuse Keppra with Kaletra (lopinavir/ritonavir)

» IV doses should be used temporarily when oral route is not feasible. To convert IV to PO, equivalent dose and frequency may be used

• PO: May be administered without regard to meals

• Administer tablets whole; do not administer partial tablets. Do not break, crush, or chew XR tablets

• Pedi: Patients <20 kg should receive oral solution. Administer with calibrated measuring device for accurate dose

• Discontinue gradually to minimize the risk of increase in seizure frequency

IV Adminstration:

• Intermittent Infusion:

Diluent: Dilute dose in 100 mL of 0.9% NaCl, D5W, or LR. Do not administer solutions that are cloudy or contain particulate matter

• Rate:
Infuse over 15 min

• Y-Site Compatibility:

» diazepam

» lorazepam

» valproate

Patient/Family Teaching

• Instruct patient to take medication as directed. Pedi: Explain to parents the importance of using calibrated measuring device for accurate dosing. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Do not discontinue abruptly; may cause increase in frequency of seizures

• May cause dizziness and somnolence. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder

• Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding. Encourage pregnant patients to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334; information is available at www.aedpregnancyregistry.org

• Instruct patient to notify health care professional of medication regimen prior to treatment or surgery

• Advise patient to carry identification describing disease process and medication regimen at all times

Evaluation/Desired Outcomes

Decrease in the frequency of or cessation of seizures

levetiracetam is a sample topic found in Davis's Drug Guide. All other sections of this record are viewable by clicking on the index in the left column, or by clicking on "Display all Sections" in the "Content Manager".

To find other Davis's Drug Guide topics, please login or purchase a subscription.