LEVETIRACETAM = LEV injectable

Last updated: October 2024

Therapeutic action

• Antiseizure (anticonvulsant)

Indications

• Second-line treatment of convulsive status epilepticus

Forms and strengths, route of administration

• 500 mg in 5 ml vial (100 mg/ml) for slow IV injection or IV infusion in 0.9% sodium chloride or 5% glucose
• DO NOT ADMINISTER THE SOLUTION UNDILUTED BY IV INJECTION. DO NOT ADMINISTER BY SC INJECTION.

Dosage and duration 

• Loading dose:
  • Child 1 month and over:
    • Use diluted solution: add 3 ml (300 mg) of LEV to 17 ml of 0.9% NaCl to obtain 20 ml of solution containing 15 mg of LEV per ml.
    • Administer 40 mg/kg (max. 3 g) over 10 minutes by IV infusion using a syringe pump or by very slow IV injection. 
    • If seizures do not stop after the end of the first dose, readminister half-dose: 20 mg/kg (max. 1.5 g) as above.
    • Do not exceed the total dose of 60 mg/kg or 4.5 g.
  • Adult:
    • 60 mg/kg (max. 4.5 g) single dose over 15 minutes 
    • Use diluted solution as above (15 mg/ml) if administered by IV infusion using a syringe pump.
    • Use undiluted solution if administered by IV infusion in a bag of 100 ml of 0.9% NaCl.

In children and adult, do not exceed an infusion rate of 5 mg/kg/minute.

• If maintenance treatment is indicated after the loading dose: change to oral route as soon as possible.

Contra-indications, adverse effects, precautions

• Administer with caution to patients with renal impairment (reduce dosage) or heart disorders.
• May cause:
  • drowsiness, headache, asthenia, dizziness, behavioural disturbances;
  • haematologic disorders, gastrointestinal disturbances, cough, nasopharyngitis;
  • rarely: QT prolongation, hypersensitivity reactions sometimes severe;
  • respiratory depression and coma in the event of overdose.
• Avoid or monitor the combination with:
  • mefloquine (reduced effect of LEV);
  • drugs that prolong the QT interval (antimalarials, antipsychotics, fluconazole, fluoroquinolones, hydroxyzine, macrolides, ondansetron, etc.);
  • benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines (hydroxyzine, promethazine), antidepressants, other antiseizure medications, etc. (increased sedation).
• Pregnancy and breast-feeding: the risks linked to status epilepticus appear greater than risks linked to LEV.

Remarks

• Do not mix with other drugs in the same syringe or infusion.

Storage