levetiracetam: clinical use

Prescribing considerations

• Select a formulation appropriate to age, weight, swallowing ability, enteral access and required precision.
• Assess renal function because clearance is closely related to creatinine clearance; severe hepatic impairment may mask concurrent renal dysfunction.
• Avoid abrupt withdrawal unless immediate cessation is required for a serious adverse reaction.
• Review treatment before pregnancy and monitor seizure control during pregnancy because plasma concentrations may fall.
• Consider cardiac history, electrolyte disturbance and other QT-prolonging medicines because rare QT prolongation has been reported.

Contraindications and cautions

• Hypersensitivity to levetiracetam, another pyrrolidone derivative or a listed product excipient.
• Check formulation-specific excipients and restrictions, including sugars in selected Neuraxpharm granules.

Monitoring

• Seizure control, adherence and paradoxical seizure worsening.
• Mood, behaviour, aggression, depression, psychotic symptoms and suicidal thinking.
• Renal function, particularly in older people or known renal impairment.
• Full blood count if substantial weakness, fever, recurrent infection or abnormal bleeding develops.
• Clinical response during pregnancy; concentration monitoring may be useful when clinically indicated.

Clinical pharmacology

Levetiracetam binds synaptic vesicle protein 2A. It has low protein binding, little clinically significant CYP-mediated interaction potential and is eliminated predominantly through the kidneys; clearance falls with renal impairment.

Formulation and product differences

• Film-coated tablets are swallowed with liquid; divisibility is product-specific.
• Zolvum is an orodispersible tablet that disintegrates on the tongue and may be swallowed without water.
• Neuraxpharm granules are dissolved in water and consumed immediately; they contain formulation-specific sugars.
• Desitrend coated granules may be swallowed with liquid or prepared for administration through a feeding tube according to its product information.
• The infusion concentrate is for intravenous use when oral treatment is temporarily impractical; its licensed paediatric age range differs from oral products.

Solution for infusion

Route: Intravenous

Strengths: 100 mg/mL

Dispersible tablet

Route: Oral

Strengths: 500 mg

Oral solution

Route: Oral

Strengths: 100 mg/mL, 250 mg, 500 mg, 750 mg, 1000 mg, 1500 mg