Levetiracetam (Oral)

Although it cannot cure epilepsy, levetiracetam can help to manage the more violent symptoms of an epileptic seizure, but only for as long as you are actually taking the medicine.

Overview

Levetiracetam belongs to the class of drugs known as anti-convulsants and is especially well suited for the control of the symptoms attending an epileptic seizure. It may also decrease the frequency of seizures, although research has been inconclusive in confirming this. Whenever you get a prescription filled from your pharmacist, you will be given a Patient Information Guide, which will provide all information you need about proper use and dosage. You should read through this guide each time you get a prescription refill, because some of the information in the Guide may have changed since your last refill.

Both the liquid solution and tablet forms of this medication are generally taken twice daily, but if you are using the tablet form, you should not break, chew, crush, or open the tablet, and should instead swallow it whole. You can then flush it down with a glass of water to be sure that all the medicine reaches your interior.

If the tablet is crushed or chewed, that would have the effect of releasing all the medicine at once, which is not a desirable situation. The medicine is intended to have a time-release effect, so as to provide ongoing coverage for a longer period of time. There is also an increased likelihood of side effects being experienced by the patient, and that those side effects will be increased in severity because all the medication is being released at once.

Condition Treated

  • Seizures due to epilepsy

Type Of Medicine

  • Anti-convulsants

Side Effects

In addition to the beneficial effects it provides at managing epileptic seizures, levetiracetam also may carry some unwanted side effects which might affect some patients. Not every patient will experience side effects, but some will feel them to a relatively severe degree. This mostly depends on body chemistry, and everyone will react differently to a new medication being taken. If you should observe any of the side effects listed below, you should consult with your doctor and be prepared to describe both the effects you are experiencing and the severity to which they are being expressed. One of the first and most serious side effects to be aware of is that of an allergic reaction. The reason that this can be so serious is that the symptoms which appear during an allergic reaction have the potential to be life-threatening, although this rarely happens. If you suspect you are having an allergic reaction, you should seek emergency medical treatment, so the symptoms don't progress into something which could prove disastrous.

Here are the symptoms to look for an allergic reaction:

  • Itchiness at various locations all around the body
  • Tightness in the chest, usually accompanied by severe difficulty with your breathing
  • Hives and or rashes appearing on skin surfaces
  • Lightheadedness or dizziness, as though you are about to pass out
  • Severe puffiness or swelling in the eyelids, or in the tongue, lips, or throat.

Some of the more commonly experienced side effects are listed below, and if any of these should reach the point where they become uncomfortable to you, contact your doctor at the earliest opportunity for consultation:

  • Painful or difficult urination
  • Nausea and/or vomiting
  • Mental depression
  • Muscle pains and aches
  • Severe diarrhea
  • Crying
  • Coughing or hoarseness of the voice
  • Chills and/or fevers
  • Anxiety
  • Changes in personality
  • Shivering and shaking
  • Restlessness or agitation
  • Sore throat
  • Unusual drowsiness
  • Rapidly changing moods
  • Hyperventilation
  • Headaches
  • Pain in your joints
  • Loss of appetite
  • Dry mouth
  • Euphoria
  • Depression or anger
  • Emotional overreaction
  • Runny nose or congestion
  • Profuse sweating
  • Difficulty with sleeping
  • Difficulty with concentrating
  • Shakiness in the hands, feet, arms, or legs
  • Difficulty with walking
  • A sensation of spinning
  • Loss of memory
  • Feeling that your surroundings are in motion
  • Blurry vision or double vision
  • Clumsiness or awkwardness
  • Tingling feelings or numbness all around the body
  • Seizures
  • Unsteadiness or difficulty with muscle usage
  • Swelling or redness in the ears
  • Tenderness around the cheekbones and the eyes
  • Uncharacteristic outbursts of anger
  • Loss of bladder control
  • Feeling of emptiness or sadness
  • Suicidal thoughts or feelings
  • Forgetfulness
  • Swollen joints
  • Swollen glands
  • Paleness of the skin
  • Red lesions on the skin, sometimes with a purple center
  • Eyes which are irritated and red
  • Continuing stomach pain or cramps
  • Bleeding gums
  • Peeling, blistering, or loosening of the skin
  • Sensation of fullness or bloating
  • Urine which contains blood
  • Stools which contain blood
  • Chest pains
  • Constipation
  • Dark-colored urine
  • Fast or irregular heartbeat
  • High fevers
  • Indigestion
  • Itchiness all around the body
  • Pains in the side, stomach, or abdomen, often radiating toward your back
  • Paleness of the skin
  • Ulcers, white spots, or sores which appear in the mouth or around the lips
  • Abdominal pains or cramps
  • Difficulty with balance
  • Yellowish tinge to the skin or around the eyes
  • Weight loss
  • Unexplained bruising or bleeding
  • Uncontrollable movements of the cheeks, lips, or tongue
  • Uncontrolled twisting or jerking of the legs, hands, or arms
  • Loss of energy
  • Unusual weak feeling
  • Changes in your voice
  • Itchiness around the eyes
  • Change in skin color
  • Increase of coughing
  • Rashes and/or hives
  • Persistent sneezing
  • Thinning of the hair or hair loss
  • Rashes on the skin which can become scaly, encrusted, and sometimes oozing pus.

Dosage

The dosages listed below are only to be considered standard dosages, and not what you personally should be taking for your own routine. Your doctor will determine an appropriate dosage level for you based on a number of factors, such as your body's tolerance to the medication, the strength of the medicine itself, the medical condition you are being treated for, the frequency of dosing throughout the day, and the total period of time which you have been taking the medicine.

For an adult dosage treating epilepsy:

  • For partial onset seizures ' the oral form of the medication with immediate release property, 1000 mg to be taken daily over two separate dosages of 500 mg each. Increments and dosage of 1000 mg per day can be allowed up to a maximum daily dosage of 3000 mg. There is no credible evidence which suggests that more than 3000 g per day will provide any additional benefit or any better control of seizure symptoms.
  • For oral tablets of the extended release variety, recommended dosages 1000 mg per day with increments of 1000 mg every two weeks, up to a maximum dosage per day of 3000 mg
  • For myoclonic seizures in patients having juvenile myoclonic epilepsy'the oral immediate release tablet should be taken to strengthen 1000 mg per day over two separate dosages of 500 mg. This can be increased by means of 1000 mg per day every two weeks, until a maximum daily dosage reaching 3000 mg per day has been achieved. Again, there is no evidence to suggest that ingesting more than 3000 mg per day will carry any additional benefit in the management of epileptic symptoms
  • For patients being treated for primary generalized tonic-clonic seizures 'the oral immediate release capsule can be taken to strengthen 1000 mg per day, which should be delivered into separate dosages of 500 mg. This can be increased by increments of 1000 mg every two weeks, up to a daily maximum dosage of 3000 mg.

For an adult dosage the treatment of seizures:

  • The oral immediate release capsule should be taken in strength the 1000 mg daily, delivered in two separate dosages of 500 mg twice a day. This can be incremented by 1000 mg every two weeks, until reaches a maximum daily dosage of 3000 mg
  • For the oral extended-release tablet ' should be taken in strength of 1000 times per day, with a potential increase in increments of up to 1000 mg every two weeks, until a maximum daily dosage of 3000 mg is achieved
  • For myoclonic seizures in patients with juvenile myoclonic epilepsy ' the oral immediate release template can begin a strength of 1000 mg today per day, administered into dosages of 500 mg daily. This can be increased by 1000 mg every two weeks, until a maximum daily dosage of 3000 mg has been achieved
  • For the treatment of primary generalized tonic-clonic seizures ' the oral immediate release tablet can be given a strength of 1000 mg per day, administered during two separate dosages of 500 mg. An increase of 1000 mg per day can be administered every two weeks until a maximum daily dosage of 3000 mg has been reached

Pediatric dosage for the treatment of epilepsy is as follows

  • The line for just one month to six months ' 7 mg per kilograms two times daily
  • For patients aged six months to less than four years ' 10 mg per kilogram, delivered twice daily
  • For patients aged four years to 16 years'10 mg per kilogram delivered twice daily
  • For patients aged 16 years and older 'an adult dosage should be administered
  • For the oral immediate-release tablets ' children between ages of four and 16 should take 10 mg per kilogram twice each day
  • Patients with a body weight of 20 kg or less should use the oral solution
  • Patients with body weight above 20 to kilograms can use either the oral solution or tablets
  • When using the film-coated tablets 'patients aged one month to less than six months'7 mg per kilogram twice a day
  • For patients age 6 months to less than four years ' 10 mg per kilogram twice each day
  • For patients aged four years to less than 16 years'10 mg per kilogram twice each day
  • For pediatric patients weighing between 20 and 40 kg ' using initial treatment of 500 mg twice each day
  • For pediatric patients weighing more than 40 kg' using initial treatment of 1000 mg delivered in two separate doses of 500 mg daily

Interactions

As with most drugs, there is a potential for this medication to interact with other drugs that you may be taking already, and these interactions may take the form of adverse side effects which you will experience, or it may worsen the side effects that you would have experienced without such interactions. There is also a chance that the form of interaction taken is that either or both of the drugs interacting will be decreased in their effectiveness, and rendered much less useful than they might have been without interaction.

To avoid either of these scenarios, it's advisable that you prepare a list of your medications, including all vitamins, herbal supplements, over-the-counter drugs, and prescription drugs, as well as each of the dosages of these. Your doctor can then review this list and make a determination on whether there is a potential for interaction between any of the drugs on your list and levetiracetam.

You can also use this list if you should have to make an unscheduled trip to the emergency room or to visit any other healthcare clinic where your primary doctor is not in residence. A doctor at either of these facilities will be able to examine your medication list, and safely prescribe a program of treatment for your condition which does not interfere with any of the drugs you're currently taking.

Some of the drugs which are most commonly checked by doctors which have the potential for interacting with levetiracetam are the following:

  • Albuterol
  • Lacosamide
  • Acetaminophen
  • Temozolomide
  • Quetiapine
  • Clopidogrel
  • Phenytoin
  • Fluticasone
  • Salmeterol
  • Ibuprofen
  • Diphenhydramine
  • Metoprolol
  • Pregabalin
  • Atorvastatin
  • Insulin glargine
  • Gabapentin
  • Rosuvastatin
  • Carbamazepine
  • Cyanocobalamin
  • Ascorbic acid
  • Cholecalciferol
  • Warfarin
  • Oxcarbazepine
  • Esomeprazole
  • Polyethylene glycol 3350
  • Omega-3 polyunsaturated fatty acids.

There is also a possibility for levetiracetam to impact an existing medical condition that you already have. For this reason, you should notify your doctor right away before taking this medication if you have any of the following medical conditions in your history:

  • Renal dysfunction
  • Hematologic abnormalities
  • Hemodialysis
  • Suicidal tendencies.

Warnings

There are a number of precautions and warnings which you should observe as a patient when taking levetiracetam, so as to avoid worsening any of the side effects imparted by the medication, or exacerbating any existing medical condition you may have.

One of the most important recommendations when taking this medication is that you keep all appointments with your doctor, so that regular monitoring can take place on your body's tolerance to the medication, as well has its general effectiveness in managing the symptoms being treated. These appointments with your doctor are also a good time for you to point out any of the side effects which you may be experiencing as a result of taking the medication, as well as how severe the side effects might be.

If necessary, your doctor may recommend some medical treatment for severe side effects that you're feeling. If your body is not tolerating the medication very well, your doctor may then consider some alternative treatments which would hopefully be as effective, without imparting the unwanted side effects.

There's a potential for levetiracetam to cause changes in your behavior or your moods, in addition to problems with your coordination and movements. You may also feel uncharacteristic tiredness or weakness throughout the day, which has nothing to do with any exertion level you may have gone through.

Make sure to inform your doctor right away if you experience feelings of severe depression, anger, anxiety, restlessness, or thoughts about inflicting harm on yourself. In fact, any thoughts which are troublesome or totally out of character for you should be reported to your doctor for consideration.

It's possible that you may feel severe drowsiness or dizziness after taking this medication, and that makes it inadvisable for you to drive a motor vehicle, or operate any kind of machinery in the immediate aftermath of taking this medicine. You could be a serious danger to yourself and to others if you are to attempt doing things of this nature after taking this medicine. For the same reason, you should not drink alcohol at the same time as you're taking this medication, because alcohol can have the effect of intensifying any side effects which you might experience from the medicine, including those of dizziness and/or drowsiness.

Some patients have reported very serious skin reactions when using Levetiracetam, including peeling skin, blistering skin, or loosening of the skin. It's also possible that you might notice red lesions on the skin, sometimes with a purple dot in the center. Patients have also experienced a severe outbreak of acne, rashes, or sores on their skin.

There's a possibility that you might experience persistent fevers or chills when using this medication. If this does happen, you should consult with your doctor about the advisability of continuing with this medication. It may be that your doctor recommends a reduction in the dosage until your body adjusts itself to the medication.

Do not stop taking this medication, and do not begin taking any other new medications, without consulting first with your doctor. It's possible that a sudden discontinuance of this medication will cause your seizures to return, or to become even worse than they were before. When the time comes that your doctor wants you to stop taking this medication, it will probably be in a gradual phasing-out process rather than all at once, so that these adverse side effects aren't triggered.

Women who are of childbearing age should have a thorough discussion with the family doctor about the advisability of taking levetiracetam, especially if you are pregnant or thinking about becoming pregnant. Animal studies which have been conducted on the usage of this medication show strong evidence of developmental toxicity, including malformation and other harmful effects on the young. While no corresponding research has been conducted on human populations, the strength of this evidence is compelling enough that it should serve as a powerful caution about taking this medication while pregnant. Levetiracetam should only be used by pregnant women under urgent circumstances, and only by the direct recommendation of the family doctor.

The same consideration should be used by mothers who are considering breast-feeding with their nursing infants. You should have a discussion with your doctor about the pros and cons of using this drug while nursing. On the one hand, there are obvious dangers involved with uncontrolled epileptic seizures, and if there is no other medication suitable for use in your case, that will have to be considered.

While no strong evidence exists to show that adverse effects are imparted to nursing infants, it is known that levetiracetam is passed through breastmilk to a nursing infant. The bottom line of all this is that pregnancy and breast-feeding should not normally occur for a woman who is being treated at the same time with levetiracetam. However, the dangers presented to both mother and child are probably greater if the mother would receive no treatment at all for epileptic seizures.

Storage

This medicine should be stored in its original closed container at room temperature, in a location which is not subject to any extremes of heat, cold, direct light, or moisture. Under no circumstances should it ever be frozen, since this is likely to degrade its effectiveness. Any of the conditions described above, in fact, may have the potential of impacting the effectiveness of levetiracetam, and rendering it less effective as a manager of epileptic seizure symptoms than it normally should be.

This medication should definitely be kept out of the reach of pets and small children, preferably in a spot which is so high and out of reach that it cannot be accessed even with the assistance of furniture. By the same token, levetiracetam should not be stored in a weekly pill reminder, because these are rarely equipped with adequate locking mechanisms that can prevent unwanted access.

If you suspect that a child in your household has accessed your medication, you should call the poison control center immediately and describe exactly the kind of medication that your child has swallowed. In the meantime, it's recommended that you call 911 and have your child dispatched to the emergency room immediately, at least as a precaution.

If you have unused or expired portions of this medication, you should not simply flush them down the sink or down the toilet, since there is a possibility that it can still cause harm to others if this is done. Instead, dispose of any unused medication according to the guidelines provided to you by your doctor or pharmacist. If you haven't been given any such instructions, you can also consult the FDA website maintained for this purpose, regarding the safe disposal of medicines.

Summary

Levetiracetam is a medication which is often used in conjunction with other medicines for the control of symptoms arising from an epileptic seizure. Belonging to the class of drugs known as anti-convulsants, this medication works to relieve the sometimes violent movements of such seizures, however, its effectiveness does not extend into the future, and will only manage seizures for as long as the program of treatment is still being continued.

It is available as a solution or in tablet form, and the tablets are of two varieties: either immediate release granules or extended release granules. The difference between the two is that in immediate release capsules, all the medication is released into the system at one time, and in extended-release capsules, the medication is slowly released into the system. These will be prescribed to fit circumstances of your specific medical condition, as well as the nature of the symptoms you typically experience.

This medication is available only by doctor prescription and is known by its commercial brand names of Keppra and Keppra XR. It should be noted that none of the forms of levetiracetam are able to cure any of the forms of epilepsy, but are fairly effective at managing symptoms of the disease for as long as treatment is continued.