Generality
Levetiracetam is an active ingredient used in the treatment of epilepsy .
In detail, it is used alone (monotherapy) in the treatment of partial onset seizures and in addition to other antiepileptic drugs (combination therapy) in the treatment of myoclonic seizures and primary generalized tonic-clonic seizures .
From the chemical point of view, levetiracetam is a pyrrolidone derivative whose structure is not related to that of the other antiepileptic drugs usually used in therapy.
To carry out its antiepileptic action, levetiracetam must be administered orally (tablets and oral solution), or parenterally (concentrate for solution for infusion). The use of many of the levetiracetam-containing medicines that can be administered parenterally is reserved exclusively for hospitals ; while medicines that can be taken orally can be used directly by patients at their home. The latter, in order to be dispensed, require presentation of a repeatable medical prescription (RR), however, since they are classified as Class A drugs, their cost can be reimbursed by the National Health System (SSN).
Examples of Specialties Medicines containing Levetiracetam
- Epitiram®
- Grifoxina®
- Italept®
- Keppra®
- Levetiracetam Hikma®
- Matever®
Therapeutic indications
When is the use of Levetiracetam indicated?
The use of levetiracetam is indicated in the following cases:
- In monotherapy, in adults and adolescents from 16 years of age, in the treatment of partial onset seizures, with or without secondary generalization.
- In combination therapy, in the treatment of:
- Partial onset epileptic seizures, with or without generalization, in adults, adolescents and children starting - depending on the medicinal product used - from 4 years of age, or from one month of age (in these cases, it is advisable to ask the doctor for advice and carefully read the information on the package insert of the medicine prescribed by it);
- Myoclonic seizures in adults and adolescents from 12 years of age with juvenile myoclonic epilepsy;
- Primary generalized tonic-clonic seizures (great pain) in adults and adolescents from 12 years of age with idiopathic generalized epilepsy (a particular type of epilepsy that is believed to have a genetic cause).
Warnings
Warnings and Precautions for the use of Levetiracetam
Before starting treatment with levetiracetam, it is advisable to inform your doctor if you suffer from kidney disorders or diseases .
In any case, as a precautionary measure, before taking levetiracetam-based medicines, it is advisable to inform your doctor of your health conditions, informing them of the possible presence of disorders or diseases of any kind.
Furthermore, during treatment with levetiracetam, it is essential to contact the doctor immediately:
- In the event that suicidal and self-injuring thoughts occur;
- In the event that epileptic seizures worsen (for example, increase in frequency).
At the same time, if the active ingredient is taken by children, it is necessary to contact the doctor immediately if, during the treatment, growth slowdowns are noticed or there is an unexpected development of puberty .
Please note
Levetiracetam intake can cause side effects (drowsiness, dizziness, etc.) that can affect the ability to drive and / or use machines. Therefore, extreme caution is advised and these activities should be avoided if the aforementioned side effects occur.
Pharmacological Interactions
Interactions between Levetiracetam and Other Drugs
During treatment with levetiracetam, it is necessary to avoid taking macrogol (an active ingredient with a laxative action) one hour before and one hour after taking the active ingredient in question, since a reduction in its therapeutic efficacy may occur.
However, before starting levetiracetam therapy, you need to tell your doctor if you are taking, or have recently taken, any drugs or products of any kind, including medicines without a prescription (SOP). ), OTC drugs, herbal and herbal products and homeopathic products.
Side effects
Side Effects Caused by Levetiracetam Intake
Like any other active ingredient, levetiracetam can also cause side effects, although not all patients manifest them or manifest them in the same way. In fact, each person reacts subjectively to the administration of the drug manifesting side effects that are different in type and intensity, or not manifesting them at all.
Nervous system disorders
Treatment with levetiracetam may cause:
- Drowsiness;
- Headache;
- dizziness;
- Tremors;
- paresthesia;
- Lethargy;
- Balance disorders;
- Convulsions;
- Memory alterations and amnesia;
- Dyskinesia;
- hyperkinesia;
- Choreoathetosis.
Psychiatric disorders
Levetiracetam intake could favor the onset of:
- Depression;
- Agitation and aggression;
- Nervousness and irritability;
- Suicidal and self-defeating ideas;
- Mood swings;
- Confusion;
- Personality disorders.
Blood disorders
Leukopenia, thrombocytopenia, neutropenia, agranulocytosis or pancytopenia may occur during treatment with levetiracetam.
Gastrointestinal disorders
Levetiracetam therapy may give rise to:
- Abdominal pain;
- Dyspepsia;
- Nausea and / or vomiting;
- Diarrhea;
- Pancreatitis.
Skin and subcutaneous tissue disorders
Levetiracetam intake may cause:
- Skin rash;
- Itch;
- Eczema;
- Alopecia;
- Stevens-Johnson syndrome or toxic epidermal necrolysis.
Other side effects
Other side effects that could occur during treatment with levetiracetam are:
- Allergic reactions, even serious, in sensitive individuals;
- Dizziness;
- rhinopharyngitis;
- Cough;
- Fatigue;
- Asthenia;
- Anorexia;
- Loss or increase in body weight;
- Hyponatremia;
- Visual disturbances;
- Hepatic failure;
- Alteration of liver function tests;
- Muscular pain and weakness;
- Rhabdomyolysis;
- Acute renal injury.
Overdose
In the event of levetiracetam overdose, the following symptoms may occur:
- Drowsiness;
- agitation;
- Aggression;
- Decreased attention;
- Inhibition of breath;
- Coma.
Gastric lavage or induction of vomiting may prove useful. Unfortunately, there is no specific antidote, therefore, the treatment is symptomatic and supportive .
In the event of an overdose of levetiracetam - ascertained or presumed to be - it is therefore advisable to go to the nearest emergency room, taking care to bring the packaging of the medicine taken with you.
Action mechanism
How does Levetiracetam work?
The mechanism of action by which levetiracetam is able to carry out its antiepileptic activity has not yet been fully clarified. However, it is agreed that its mode of action is different from that of the other antiepileptic drugs commonly used in the clinical setting.
In vitro studies have identified a specific binding site of levetiracetam on synaptic vesicular protein 2A (SV2A) that appears to be involved in the regulation of calcium-mediated synaptic transmission . In light of what has just been said, therefore, it is believed that this link can be involved in the antiepileptic action of levetiracetam.
Furthermore, in vitro studies have shown that levetiracetam is also capable of:
- Exert a partial inhibition of calcium currents (Ca2 +) of type N;
- Reduce the release of calcium ions (Ca2 +) from intraneuronal deposit sites;
- Partially reverse the reduction - induced by β-carboline and zinc - of the currents induced by GABA (gamma-aminobutyric acid) and glycine.
Therefore, it is likely that all of these activities contribute to the antiepileptic action exerted by the active ingredient in question.
Use and Posology
How to take Levetiracetam
Levetiracetam can be taken orally (coated tablets, oral solution), or intravenously (concentrate for solution for infusion). The latter must necessarily be administered by specialized healthcare personnel (we recall, in fact, that many of the levetiracetam-based medicines that can be administered parenterally can only be used at hospital level).
Tablets and oral solution should be taken by patients in the manner and with the frequency indicated by the doctor.
The exact dosage of levetiracetam (dosage, frequency of administration, duration of treatment) is established by the doctor on an individual basis for each individual. In fact, it may vary according to the type of epileptic seizure that needs to be treated, the possible association with other active ingredients and depending on the individual response of the same patient to the therapy.
However, below are the doses usually used in therapy which, however, we remember could be changed by the doctor.
Regardless of the pharmaceutical formulation chosen - therefore, regardless of the route of administration used - the doses of levetiracetam usually used are the following:
- Adults and adolescents from 12 to 17 years of age with a body weight over 50 kg: from 1000 mg to 3000 mg of levetiracetam per day.
- Children under 12 years of age and infants (for medicines containing levetiracetam whose use is allowed from the first months of life): the dose of levetiracetam to be administered varies mainly depending on the patient's body weight and is established by the case doctor by chance.
Please note
Normally, treatment with levetiracetam is chronic and should NOT be interrupted unless expressly indicated by the doctor.
Pregnancy and breastfeeding
Can Levetiracetam be taken during pregnancy and during breastfeeding?
Generally, the use of levetiracetam in pregnant women is not recommended unless absolutely necessary . In this case, future mothers will be constantly monitored by the doctor.
Because levetiracetam is excreted in breast milk, its use in breast-feeding mothers is not recommended . If treatment with levetiracetam is essential, the doctor may advise you to stop breastfeeding.
Contraindications
When Levetiracetam should not be used
The use of levetiracetam is contraindicated in case of known hypersensitivity to levetiracetam itself and / or to one or more of the excipients present in the medicinal product to be taken.
Please note
For more in-depth information on indications, warnings and precautions, interactions, side effects, use during pregnancy and during lactation and contraindications of the different types of medicines based on levetiracetam, it is advisable to consult your doctor and read carefully the package insert for the medicinal product to be used.
