LEVETIRACETAM = LEV oral

Last updated: October 2024

Therapeutic action

• Antiseizure (antiepileptic) 

Indications

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

Forms and strengths

• 250 mg, 500 mg, 750 mg and 1 g tablets
• 500 mg/5 ml oral solution, to be administered using a measuring device (oral syringe, measuring spoon, or cup with graduations)

Dosage

Start with a low dose then increase gradually based on patient's response and tolerance. 

• Child 1 to 5 months: start with 7 mg/kg once daily; increase to 7 mg/kg 2 times daily after 2 weeks, then by increments of 7 mg/kg 2 times daily every 2 weeks if necessary (max. 21 mg/kg 2 times daily).
• Child 6 months to 17 years (< 50 kg): start with 10 mg/kg once daily; increase to 10 mg/kg 2 times daily after 2 weeks, then by increments of 10 mg/kg 2 times daily every 2 weeks if necessary (max. 30 mg/kg 2 times daily).
• Child 50 kg and over and adult: start with 250 mg 2 times daily; increase to 500 mg 2 times daily after 2 to 4 weeks, then by increments of 500 mg 2 times daily every 2 to 4 weeks if necessary (max. 1.5 g 2 times daily).

Duration

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

Contra-indications, adverse effects, precautions

• Administer with caution to patients with renal impairment (reduce dosage) or heart disorders.
• May cause:
  • drowsiness (caution when driving/operating machinery), headache, asthenia, dizziness, mood and behavioural disturbances, anxiety, depression, insomnia;
  • haematologic disorders, gastrointestinal disturbances, cough, nasopharyngitis;
  • rarely: QT prolongation, hypersensitivity reactions (including severe cutaneous reactions such as Stevens-Johnson, Lyell and DRESS syndromes). In these cases stop treatment. Early symptoms such as fever, rash, mouth ulcers and bleeding require immediate medical attention. 
  • 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.);
  • drugs containing alcohol, benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines (hydroxyzine, promethazine), antidepressants, other antiseizure medications, etc. (increased sedation).
• Avoid alcohol during treatment (increased risk of adverse effects).

• Pregnancy: use the lowest effective dose.

  • Administer folic acid high dose (5 mg daily) during the first trimester. Start as soon as possible, including during the preconception period in case of planned pregnancy.
  • 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

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

Storage