Levetiracetam , marketed under the trade name Keppra among others, is a drug used to treat epilepsy. This is used for seizures of partial, myoclonic, or tonic-clonic seizures. This is the S-enantiomer of etiracetam.
Levetiracetam is available by mouth in two forms: immediate release and extended release. It is also available with injections. The release tablet soon has been available as a generic in the United States since November 2008, and in the UK since 2011. The US patent for extended release tablets will expire on September 17, 2028. Originally patented by UCB Pharma.
Video Levetiracetam
Medical use
Levetiracetam has been approved in the United States as an adjunct treatment for partial (focal), myoclonic, and tonic-clonic seizures. Levetiracetam has been approved in the EU as a monotherapy treatment for epilepsy in cases of partial seizures, or as adjuvant therapy for partial, myoclonic, and tonic-clonic seizures. Levetiracetam has been shown to reduce partial (focal) seizures by 50% or more as additional drugs. It is also used in veterinary medicine for similar purposes.
Levetiracetam is sometimes used off-label to treat epileptic status or to prevent seizures associated with subarakhnoid hemorrhage.
Levetiracetam has potential benefits for other psychiatric and neurological conditions such as Tourette's syndrome, anxiety disorder, and Alzheimer's disease. However, the most serious side effects are behavior, and the risk-benefit ratio under these conditions is not well understood.
Levetiracetam has not been found useful for the treatment of neuropathic pain, or for treatment of essential tremor. Levetiracetam has not been found useful for treating autism, but is an effective treatment for partial, myoclonic, or tonic-clonic seizures associated with autism spectrum disorders.
Pregnancy
Levetiracetam is a category C pregnancy drug. Studies in female pregnant rats have shown small fetal bone abnormalities when given the maximum recommended dose of human levetiracetam during pregnancy and lactation. [14]
Elderly
Studies were conducted to look for increased side effects in the elderly population compared with younger patients. One study published in Epilepsy Research showed no significant improvement in the incidence of adverse symptoms experienced by young or elderly patients with central nervous system (CNS) disorders. [16]
Children
Levetiracetam may be safely used with caution in children over the age of 4. However, it has not been determined whether it can be safely administered to children under 4 years of age.
Kidney disorders
Kidney disorders decrease the rate of levetiracetam elimination from the body. Individuals with reduced kidney function may require dose adjustment. Kidney function can be estimated from the level of creatinine cleansing.
Liver damage
Adjustment of levetiracetam dose is not required in liver disorders.
Maps Levetiracetam
Adverse effects
The most common side effects of levetiracetam treatment include CNS effects such as somnolene, decreased energy, headache, dizziness, mood swings and coordination difficulties. This adverse effect is most prominent in the first month of therapy. About 4% of patients drop out of pre-approval clinical trials because of these side effects.
Approximately 13% of people taking levetiracetam have poor neuropsychiatric symptoms, which are usually mild. These include agitation, hostility, apathy, anxiety, emotion, and depression. Adverse side effects of serious psychiatric reversal with discontinuation of the drug occur in about 1%. These include hallucinations, thoughts of suicide, or psychosis. This occurs mostly within the first month of therapy, but they can develop at any time during treatment.
A study published in 2005 showed that the addition of pyridoxine (vitamin B6) may reduce some psychiatric symptoms.
Although rare, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which appears as a rash that spreads with redness and blistering and/or peeling skin, has been reported in patients treated with levetiracetam. The SJS incidence following anti-epileptic exposure such as levetiracetam is about 1 in 3,000.
Levetiracetam should not be used in people who have previously demonstrated hypersensitivity to levetiracetam or any of the inactive ingredients in tablets or oral solutions. Such hypersensitivity reactions include, but are not limited to, rash for no reason with redness or blistering skin, difficulty in breathing, and tightness in the chest or airways.
In one study, the incidence of decreased bone mineral density of patients in levetiracetam was significantly higher than that of other epilepsy drugs.
Suicide
Levetiracetam, along with other anti-epileptic drugs, may increase the risk of suicidal behavior or thoughts. People taking levetiracetam should be closely monitored for signs of depression that worsen, suicidal thoughts or tendencies, or emotional states or behaviors that change.
Drug interactions
No significant pharmacokinetic interactions were observed between levetiracetam or its major metabolites and co-drugs. The levetiracetam pharmacokinetic profile is not affected by phenytoin, phenobarbital, primidone, carbamazepine, valproic acid, lamotrigine, gabapentin, digoxin, ethinylestradiol, or warfarin.
Action mechanism
The exact mechanism by which levetiracetam acts to treat epilepsy is unknown. However, the drug binds to SV2A, synaptic vesic glycoprotein, and inhibits presinaptic calcium channels, reduces the release of neurotransmitters and acts as a neuromodulator. This is believed to inhibit the conduction of impulses throughout the synapses.
Pharmacokinetics
Absorption
The absorption of levetiracetam tablets and oral solution is quick and basically complete. The bioavailability of levetiracetam is close to 100 percent, and the effect of food on small absorption.
Distribution
The volume of levetiracetam distribution is similar to total body water. Simple Levetiracetam binds plasma proteins (less than 10%).
Metabolism
Levetiracetam does not undergo extensive metabolism, and the metabolites are inactive and do not perform pharmacological activity. Levetiracetam metabolism not by the liver cytochrome P450 enzyme, but through other metabolic pathways such as hydrolysis and hydroxylation.
Excression
Levetiracetam is removed from the body primarily by the kidneys with about 66 percent of the original drug being passed unchanged into urine. The half-life of levetiracetam plasma in adults is about 6 to 8 hours.
Available form
Levetiracetam is available as a regular and extended release oral formulation and as an intravenous formulation.
The Keppra branded version is produced by UCB Pharmaceuticals Inc.
In 2015 the 3d-print form of the Aprecia drug is approved by the FDA.
See also
- Racetams
References
External links
- PubMed Health A division of the National Library of Medicine at the National Institutes of Health.
- Keppra (levetiracetam) Final Magazine Label April 2009. Center for Research and Drug Research, US Food and Drug Administration. Retrieved 29 July 2011.
- Keppra UCB (manufacturer website)
- Medication NIH MedLine information
Source of the article : Wikipedia
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