LEVETIRACETAM oral

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    Last updated: xxx 2023

     

    Prescription under medical supervision

     

    Therapeutic action

    • Anticonvulsant

    Indications

    • Epilepsy: generalised tonic-clonic seizures, partial (focal) seizures and absence seizures

    Forms and strengths

    • 250 mg, 500 mg, 750 mg and 1 g tablets
    • 500 mg/5 ml oral solution

    Dosage 

    • Child 1 to 5 months: 7 mg/kg once daily, then increase the dose to 7 mg/kg 2 times daily after 2 weeks if necessary, then in increments of 7 mg/kg 2 times daily every 2 weeks, up to 21 mg/kg 2 times daily max.
    • Child 6 months to 17 years (under 50 kg): 10 mg/kg once daily, then increase the dose to 10 mg/kg 2 times daily after 2 weeks if necessary, then in increments of 10 mg/kg 2 times daily every 2 weeks, up to 30 mg/kg 2 times daily max.
    • Child 50 kg and over and adult: 250 mg 2 times daily, then increase the dose to 500 mg 2 times daily after 2 to 4 weeks if necessary, then in increments of 500 mg 2 times daily every 2 to 4 weeks, up to 1500 mg 2 times daily max.

    Duration

    • As long as required. Do not stop treatment abruptly, even if changing treatment to another antiepileptic.

    Contra-indications, adverse effects, precautions

    • Administer with caution to older patients and patients with hepatic or renal impairment (reduce dosage) or heart disorders.
    • May cause:
      • hypersensitivity reactions sometimes severe;
      • central nervous system depression, drowsiness (caution when driving/operating machinery), headache, asthenia, dizziness, behavioural disturbances;
      • haematological disorders, gastrointestinal disturbances, cough, nasopharyngitis;
      • rarely, QT prolongation.
    • Administer with caution and monitor combination in patients taking:
      • drugs containing alcohol, benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines (hydroxyzine, promethazine), antidepressants, other anticonvulsants, etc. (increased sedation);
      • drugs that prolong the QT interval (antimalarials, antipsychotics, fluconazole, fluoroquinolones, hydroxyzine, macrolides, ondansetron, etc.).
    • Avoid alcohol during treatment (increased sedation).
    • Pregnancy: use only if the benefits outweigh the risks (limited data). Use the lowest effective dose.
      • Start folic acid (5 mg daily) as soon as possible (including in the preconception period in case of planned pregnancy) and continue treatment for at least the first trimester.
      • Plasma concentrations may decrease during pregnancy (monitor clinical response; increase dose if needed then resume the usual dose after delivery). 
    • Breast-feeding: administer with caution (excreted in milk); reduce the dose if increased during pregnancy and monitor the child (risk of drowsiness and poor feeding). 

    Remarks

    • Levetiracetam can be used with contraceptive implants and oral contraceptives.

    Storage

     
    – Below 25 °C   

     

     

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