Levetiracetam (Keppra)


Excerpt from Cafer's Mood Stabilizers and Antiepileptics

 Levetiracetam (KEPPRA) 

 Pronunciation: LEE ve tye RA se tam / KEP ruh
“Levitate Keeper”
Levetiracetam (Keppra) mascot by Jason Cafer MD
Levetiracetam (Keppra) alternate mascot by Jason Cafer MD 
❖ Antiepileptic 
❖ Inhibitor of glutamate release		FDA approved for:
❖ Focal seizures (adjunct) 
❖ Juvenile myoclonic epilepsy (adjunct) 
❖ Bilateral tonic-clonic seizures (adjunct)		Used off label for: 
❖ Other types of seizures

 Levetiracetam entered the U.S. market in 2000 as an AED with a novel mechanism of action. It binds SV2A, a synaptic vesicle glycoprotein. This reduces the release of glutamate, the brain’s principal excitatory neurotransmitter, thereby preventing hypersynchronization of epileptiform burst firing.

 
Levetiracetam has become one of the most prescribed medications for the treatment of epilepsy. It is not prescribed by psychiatrists. Advantages of levetiracetam as an AED include efficacy for a broad-spectrum of seizure types, lack of cognitive impairment, and  lack of drug interactions. It can be started at an effective 500 mg BID dose on day one, which is also nice. Half-life is about 7 hours. 66% is excreted unchanged in the urine.

The most common side effects are dizziness, fatigue, and insomnia. The more troublesome problem with Keppra can be irritability and mood changes. This may occur to some degree in up to a third of patients taking the medicine (Dr. Robert Fisher, epilepsy.com). The array of psychiatric adverse effects may include depression, suicidal ideation, psychosis, hostility, and aggression.  If a patient on Keppra experiences behavioral disturbance, they can be switched to brivaracetam (Briviact), a similar AED with a lower incidence of mood disruption.

Dosing: A typical adult dose for levetiracetam is 500–1500 mg twice a day. Dr. Fisher usually starts with 250 mg BID x 1 wk, then 500 mg BID x 1 wk, then 1000 mg AM + 500 mg PM x 1 wk, then 1000 mg BID. This is slower than the package insert suggests. 

Dynamic interactions: 
❖ Sedation (minimal)		Keppra has no significant pharmacokinetic interactions by jason cafer mdKinetic interactions:
❖ None significant - “in a bubble”
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