Overview
Levetiracetam is an antiepileptic drug (AED) used to treat partial-onset, myoclonic, and primary generalized tonic-clonic seizures in adults and children. It is a pyrrolidone derivative with a unique mechanism of action distinct from other AEDs. It is generally well-tolerated with a favorable pharmacokinetic profile (linear kinetics, minimal protein binding, primarily renal excretion).
Mechanism of Action
The exact mechanism is not fully understood. It is believed to bind selectively to synaptic vesicle protein 2A (SV2A) in the brain, which is involved in synaptic vesicle exocytosis. This modulation is thought to inhibit presynaptic neurotransmitter release, stabilizing neuronal membranes and reducing neuronal hyperexcitability.
Indications
- Adjunctive therapy in the treatment of partial-onset seizures in adults and children 1 month of age and older with epilepsy
- Adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with Juvenile Myoclonic Epilepsy
- Adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with Idiopathic Generalized Epilepsy
Dosage
Dosage must be individualized based on clinical response and tolerability. Adults and adolescents (>16 years): Start 500 mg twice daily; may increase by 1000 mg/day every 2 weeks to max 3000 mg/day. Children: Dosing is weight-based. Renal impairment requires dose adjustment. Administer orally with or without food.
Contraindications
- Hypersensitivity to levetiracetam, other pyrrolidone derivatives, or any excipient
Side Effects
- Common: Somnolence, asthenia, dizziness, headache, infection
- Behavioral: Agitation, aggression, anxiety, depression, emotional lability
- Gastrointestinal: Anorexia, nausea, vomiting
- Other: Coordination difficulties, fatigue, nasopharyngitis
Interactions
- Minimal pharmacokinetic interactions. Does not significantly induce or inhibit CYP450 enzymes.
- May potentiate effects of other CNS depressants (alcohol, benzodiazepines).
- Not affected by enzyme-inducing AEDs (e.g., carbamazepine, phenytoin).