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Levetiracetam

LEVETIRACETAM
cp 1

Dr. C P Ravi Kumar

LEVETIRACETAM :

it is antiseizure drug used to treat the patients with Epilepsy.

What is Levetiracetam used for?

  • Focal onset seizures and generalized seizures
  • Status epilepticus
  • Subarachnoid hemorrhage
  • Traumatic brain injury

How is levetiracetam available?

Syrup
Immediate-release tablet
Extended-release (long-acting) tablet
Injection

How does levetiracetam act?

It acts by interfering with the transmission of abnormal nerve signals in the brain thereby reducing the episodes of seizure

Why is Levetiracetam important for you/your child’s treatment?

It is important that your child takes Levetiracetam regularly so that you/your child doesn’t suffer from Seizures or have fewer seizures episodes.

Levetiracetam controls seizures but doesn’t cure epilepsy and works only while you keep taking it. So do not stop giving Levetiracetam all of a sudden, as it may result in having more seizures.

When should Levetiracetam be taken?

Levetiracetam can be taken before or after food, but follow the same on each day.
If taking twice a day, leave a gap of 10-12 hours between the doses.
It is recommended to give the medication at the same time each day to help establish a routine and minimize the risk of forgetting a dose.

What if I miss a dose?

If you miss the dose, it can be taken as soon as you remember within the lapse of 6 hours. Do not take the missed dose if it is close to the next one; just take the next dose as normal. If you miss two or more doses, discuss with your doctor.

NEVER GIVE A DOUBLE DOSE OF LEVETIRACETAM.

If your child vomits out the content within 30 minutes of taking the medicine dosage then you can give the dose again; but if your child vomits after 30 minutes of taking the dose, then just leave it be and do not give it again.

How much of the drug should be given?

It is mandatory to follow the instructions given by your doctor about the dosage of medication. Your doctor may start you on a low dose of levetiracetam and gradually increase your dose, not more often than once every 2 weeks.

How should I give the medicine?

Tablets: A whole tablet must be swallowed with a glass of water, juice or milk. You may give it by crushing and mixing it in water/ juice or small serving of yogurt / Curd.
Swallow the levetiracetam immediate-release and extended-release tablets whole; do not split, chew, or crush them.
Liquid or syrup: Use an oral syringe or a medicine spoon to measure the adequate amount. You can easily get these from any pharmacy nearby. Do not use a kitchen teaspoon as it will not give the accurate amount of the drug.

Could this medication have any side effects on my child? Read about Side effects here

Every medication has both positive and potential negative effects. Fortunately, adverse effects are not common for everyone, but it’s essential to be aware of them. Understanding possible side effects allows us to act quickly and effectively if they occur, ensuring that we can address any concerns promptly while continuing to benefit from the intended effects of medications.
Even though it may be rare, few people sometimes may have serious side effects when taking a drug. Consult your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

Side Effects :

> 10%: common
  • Nervous system: Behavioral problems such as aggression, agitation, anger, anxiety, headache, psychotic symptoms, drowsiness.
  • Heart related (Cardiovascular): Increased heart rate (Hypertension)
  • Gastrointestinal: Vomiting
  • Neuromuscular and skeletal: Muscle pain (Myalgia), Muscle weakness

1-10%: less common
  • Nervous system: Aggressive behavior, Dizziness, tiredness (lethargy), oversleep (insomnia), loss of balance (vertigo), depression, mood changes, inability to coordinate (ataxia), sleepiness (sedation), suicidal ideation.
  • Lungs related (Respiratory): Nasal congestion, cough, stuffy nose (rhinitis).
  • Gastrointestinal: Upper abdominal pain, decreased appetite, anorexia, constipation.
  • Hematological: Increased eosinophil counts (eosinophilia), decreased WBC and neutrophils counts.
  • Musco-skeletal: Neck pain, joint pain (arthralgia) and joint sprain.
  • Ophthalmic: Double vision (Diplopia), conjunctivitis.

<1%: Rare
  • Abnormal hepatic function tests
  • Acute renal failure
  • Reduced white blood cells (agranulocytosis)
  • Hair loss (Alopecia)
  • Steven Johnson Syndrome
  • Toxic epidermal necrolysis
  • Erythema Multiforme
  • Drug Reaction with eosinophilia and systemic symptoms
  • Reduced sodium level (Hyponatremia)

Pregnancy and Lactation:

  • The quantity of Levetiracetam secreted in the milk varies, it does not correlate with the dose taken by the mother.
  • The potential effect on the baby has to be discussed with the treating doctor.
  • Should be closely monitored during pregnancy and postpartum due to pregnancy-induced psychological changes.

Withdrawal:

Drug should not be discontinued abruptly because the possibility of increasing seizure frequency; therapy should be withdrawn gradually to minimize the potential of seizure breakthrough.

Monitoring Parameters:

  • Renal function test
  • Blood pressure
  • CNS depression (abnormal walking (gait), impaired coordination, weakness, somnolence)
  • Psychiatric and behavior symptoms (aggression, agitation, anger, anxiety, confusion, suicidal thoughts)
  • Patients must be cautious against performing tasks that require mental alertness such as machinery or driving.

How to cope with side effects:

    Behavioural Changes: This can include irritability, mood swings, or aggression. Engage in calming activities like reading or drawing, and provide a supportive, stable environment. Monitor closely and communicate with healthcare providers if these changes are significant. Please note, majority of children outgrow this issue within 2–4 weeks, only in 10% of children, this particular side effect is severe enough to warrant changing medicine.

    Dizziness and Coordination Issues: Some children experience dizziness or unsteady movements. Ensure a safe environment with minimal obstacles to prevent falls. Encourage slow movements when standing up or changing positions.

    Loss of Appetite: Offer nutritious, small meals throughout the day and ensure they receive enough nutrients even with a reduced appetite.

    Sleep Disturbances: Some children may have difficulty sleeping or may experience unusual dreams. Establish a calming bedtime routine, avoiding stimulating activities before bed.
Author:
1. Dr Praveen Kumar, B.Pharm,Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
2. Dr. Ramya. R, Pharm D, Clinical pharmacologist, Aster Hospitals, Bengaluru
3. Dr C P Ravi Kumar, Consultant Paediatric Neurologist, Aster CMI Hospital
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