Indications for KEPPRA:
Partial onset seizures in patients ≥1 month old. Adjunct in myoclonic seizures in patients ≥12yrs old with juvenile myoclonic epilepsy. Adjunct in primary generalized tonic-clonic seizures in patients ≥6yrs old with idiopathic generalized epilepsy.
Swallow tabs whole. Partial onset: ≥16yrs: initially 500mg twice daily. May increase at 2-week intervals in increments of 1g/day; max 3g/day. Myoclonic: ≥12yrs: initially 500mg twice daily; increase at 2-week intervals in increments of 1g/day to target dose of 3g/day. Tonic-clonic: ≥16yrs: initially 500mg twice daily; increase at 2-week intervals by 1g/day to target dose of 3g/day. Renal impairment: CrCl 50–80mL/min: 500mg–1g every 12hrs; CrCl 30–50mL/min: 250–750mg every 12hrs; CrCl <30mL/min: 250–500mg every 12hrs; ESRD on dialysis: 500mg–1g every 24hrs and a supplement of 250–500mg post-dialysis.
Swallow tabs whole. Body wt. ≤20kg: use oral soln. Give in 2 divided doses. Partial onset: <1 month: not established. 1 month–<6mos: initially 14mg/kg/day; increase at 2-week intervals by 14mg/kg/day to target dose of 42mg/kg/day. 6mos–<4yrs: initially 20mg/kg/day; increase at 2-week intervals by 20mg/kg/day to target dose of 50mg/kg/day. 4–<16yrs: initially 20mg/kg/day; increase at 2-week intervals by 20mg/kg/day to target dose of 60mg/kg/day; max 3g/day. If using tabs (20–40kg): initially 500mg/day; increase at 2-week intervals by 500mg/day to max 1.5g/day; (≥40kg): initially 1g/day; increase at 2-week intervals by 1g/day to max 3g/day. May reduce dose if intolerant. Myoclonic: <12yrs: not established. Tonic-clonic: <6yrs: not established. 6–<16yrs: initially 20mg/kg/day; increase at 2-week intervals by 20mg/kg/day to target dose of 60mg/kg/day.
Monitor for behavioral abnormalities, psychiatric symptoms, emergence or worsening of depression, suicidal ideation, somnolence, fatigue. Hematologic abnormalities: do CBCs in those experiencing significant weakness, pyrexia, recurrent infections, or coagulation disorders. Discontinue if anaphylaxis or angioedema develops. Discontinue at the 1st sign of rash; do not resume if Stevens-Johnson syndrome or toxic epidermal necrolysis is suspected. Renal impairment. Avoid abrupt cessation. Elderly (consider monitoring renal function). Pregnancy: monitor carefully (esp. during 3rd trimester). Nursing mothers.
Somnolence, asthenia, infection, dizziness; behavioral abnormalities (eg, irritability, aggression, anger, depression, anxiety, apathy), psychotic symptoms, coordination difficulties (eg, ataxia, abnormal gait), hematologic abnormalities, dermatological reactions (may be serious). Children: also fatigue, nasal congestion, decreased appetite; BP increases in children 1 month–4yrs (monitor).
Enroll pregnant patients exposed to levetiracetam in the North American Antiepileptic Drug pregnancy registry (888) 233-2334 or the UCB AED Pregnancy Registry (888) 537-7734.
Tabs 250mg, 500mg, 750mg—120; 1000mg—60; XR—60; Soln—16oz; Single-use vials (5mL)—10