Levetiracetam: Difference between revisions

{{shortShort description|Medication}}

{{Use dmy dates|date=NovemberFebruary 20192024}}

| excretion = Urinary[[Kidney]]

Common side effects of levetiracetam include sleepiness, dizziness, feeling tired, and aggression.<ref name=AHFS2019>{{cite web |title=Levetiracetam Monograph for Professionals |url=https://www.drugs.com/monograph/levetiracetam.html |website=Drugs.com |publisher=AHFS |access-date=14 January 2019 |language=en |archive-date=24 March 2019 |archive-url=https://web.archive.org/web/20190324134138/https://www.drugs.com/monograph/levetiracetam.html |url-status=live }}</ref> Severe side effects may include [[psychosis]], [[suicide]], and [[allergic reaction]]s such as [[Stevens–Johnson syndrome]] or [[anaphylaxis]].<ref name=AHFS2019/> It is unclear if levetiracetam is safe for use during [[pregnancy]] and [[breastfeeding]].<ref name="Drugs.com pregnancy">{{cite web |title=Levetiracetam Use During Pregnancy |url=https://www.drugs.com/pregnancy/levetiracetam.html |website=Drugs.com |access-date=5 March 2019 |archive-date=6 March 2019 |archive-url=https://web.archive.org/web/20190306044746/https://www.drugs.com/pregnancy/levetiracetam.html |url-status=live }}</ref><ref>{{cite web |url=https://www.rxlist.com/consumer_levetiracetam_keppra_spritam/drugs-condition.htm#:~:text=Pregnancy%20and%20Lactation |website=RxList |access-date=19 January 2022 |title=Levetiracetam |archive-date=19 January 2022 |archive-url=https://web.archive.org/web/20220119173659/https://www.rxlist.com/consumer_levetiracetam_keppra_spritam/drugs-condition.htm#:~:text=Pregnancy%20and%20Lactation |url-status=live }}</ref> Levetiracetam is the S-[[enantiomer]] of [[etiracetam]].<ref>{{cite book | vauthors = Cavanna AE |title=Behavioural Neurology of Anti-Epileptic Drugs: A Practical Guide |date=2018 |publisher=Oxford University Press |isbn=9780198791577 |page=17 |url=https://books.google.com/books?id=QVZYDwAAQBAJ&pg=PA17 }}</ref> Its mechanism of action is not yet clear.<ref name=AHFS2019/>

Levetiracetam is sometimes used off label to treat [[status epilepticus]].<ref>{{cite journal | vauthors = Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, Laroche SM, Riviello JJ, Shutter L, Sperling MR, Treiman DM, Vespa PM | display-authors = 6 | title = Guidelines for the evaluation and management of status epilepticus | journal = Neurocritical Care | volume = 17 | issue = 1 | pages = 3–23 | date = August 2012 | pmid = 22528274 | doi = 10.1007/s12028-012-9695-z | s2cid = 4675838 | collaboration = Neurocritical Care Society Status Epilepticus Guideline Writing Committee }}</ref><ref>{{cite journal | vauthors = Meierkord H, Boon P, Engelsen B, Göcke K, Shorvon S, Tinuper P, Holtkamp M | title = EFNS guideline on the management of status epilepticus in adults | journal = European Journal of Neurology | volume = 17 | issue = 3 | pages = 348–355 | date = March 2010 | pmid = 20050893 | doi = 10.1111/j.1468-1331.2009.02917.x | s2cid = 1032139 | doi-access = free }}</ref>

Levetiracetam has not been found to be useful for treatment of [[neuropathic pain]],<ref>{{cite journal | vauthors = Crawford-Faucher A, Huijon RM | title = The Role of Levetiracetam in Treating Chronic Neuropathic Pain Symptoms | journal = American Family Physician | volume = 92 | issue = 1 | pages = 23–24 | date = July 2015 | pmid = 26132123 | url = http://www.aafp.org/link_out?pmid=26132123 | access-date = 1 September 2017 | archive-date = 29 August 2021 | archive-url = https://web.archive.org/web/20210829200854/https://www.aafp.org/afp/2015/0701/p23.html | url-status = live }}</ref> nor for treatment of [[essential tremor]]s.<ref>{{cite journal | vauthors = Zesiewicz TA, Elble RJ, Louis ED, Gronseth GS, Ondo WG, Dewey RB, Okun MS, Sullivan KL, Weiner WJ | display-authors = 6 | title = Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology | journal = Neurology | volume = 77 | issue = 19 | pages = 1752–1755 | date = November 2011 | pmid = 22013182 | pmc = 3208950 | doi = 10.1212/WNL.0b013e318236f0fd }}</ref> Levetiracetam has not been found to be useful for treating all developmental disorders within the [[autism spectrum|autism]],;<ref>{{cite journal | vauthors = Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M | title = Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 53 | issue = 2 | pages = 237–257 | date = February 2014 | pmid = 24472258 | doi = 10.1016/j.jaac.2013.10.013 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Hirota T, Veenstra-Vanderweele J, Hollander E, Kishi T | title = Antiepileptic medications in autism spectrum disorder: a systematic review and meta-analysis | journal = Journal of Autism and Developmental Disorders | volume = 44 | issue = 4 | pages = 948–957 | date = April 2014 | pmid = 24077782 | doi = 10.1007/s10803-013-1952-2 | s2cid = 36509998 }}</ref> butstudies have only proven to isbe an effective treatment for partial, myoclonic, or tonic-clonic seizures associated with autism spectrum disorder.<ref>{{cite journal | vauthors = Frye RE, Rossignol D, Casanova MF, Brown GL, Martin V, Edelson S, Coben R, Lewine J, Slattery JC, Lau C, Hardy P, Fatemi SH, Folsom TD, Macfabe D, Adams JB | display-authors = 6 | title = A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel | journal = Frontiers in Public Health | volume = 1 | pages = 31 | date = September 2013 | pmid = 24350200 | pmc = 3859980 | doi = 10.3389/fpubh.2013.00031 | doi-access = free }}</ref>

Studies in female pregnant rats have shown minor fetal skeletal abnormalities when given maximum recommended human doses of levetiracetam orally throughout pregnancy and lactation.{{medcnmedical citation needed|date=September 2020}}

Studies were conducted to look for increased adverse effects in the elderly population as compared to younger patients. One such study published in Epilepsy Research showed no significant increase in incidence of adverse symptoms experienced by young or elderly patients with central nervous system (CNS) disorders.{{medcnmedical citation needed|date=September 2020}}

About 13% of people taking levetiracetam experience adverse neuropsychiatric symptoms, which are usually mild. These include agitation, hostility, apathy, anxiety, emotional lability, and depression. Serious psychiatric adverse side effects that are reversed by drug discontinuation occur in about 1%. These include hallucinations, suicidal thoughts, or psychosis. These occurred mostly within the first month of therapy, but they could develop at any time during treatment.<ref name="pmid18728811">{{cite journal | vauthors = Gambardella A, Labate A, Colosimo E, Ambrosio R, Quattrone A | title = Monotherapy for partial epilepsy: focus on levetiracetam | journal = Neuropsychiatric Disease and Treatment | volume = 4 | issue = 1 | pages = 33–38 | date = February 2008 | pmid = 18728811 | pmc = 2515905 | doi = 10.2147/NDT.S1655 | doi-access = free }}</ref>

In persons with normal kidney function, levetiracetam is eliminated from the body primarily by the kidneys with about 66 percent of the original drug passed unchanged into urine. The plasma half-life of levetiracetam in adults is about 6 to 8 hours ,<ref name="Keppra tablet FDA label" /> although the mean CSF half life of approx. 24 hours better reflects levels at site of action.<ref>{{cite journal | vauthors = Steinhoff BJ, Staack AM | title = Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience | journal = Therapeutic Advances in Neurological Disorders | volume = 12 | pages = 1756286419873518 | date = January 2019 | pmid = 31523280 | pmc = 6734620 | doi = 10.1177/1756286419873518 }}</ref>

The immediate release tablet has been available as a [[Generic drug|generic]] in the United States since 2008, and in the UK since 2011.<ref>{{cite web |title=Patent Terms Extended Under 35 USC §156 |url=http://www.uspto.gov/patent/laws-and-regulations/patent-term-extension/patent-terms-extended-under-35-usc-156 |website=www.uspto.gov |access-date=5 November 2015-11-05 |author=Branch Website Management |archive-date=15 November 2015 |archive-url=https://web.archive.org/web/20151115194741/http://www.uspto.gov/patent/laws-and-regulations/patent-term-extension/patent-terms-extended-under-35-usc-156 |url-status=live }}</ref><ref name="Mbizvo">{{cite journal | vauthors = Mbizvo GK, Dixon P, Hutton JL, Marson AG | title = Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD001901 | date = September 2012 | volume = 2012 | pmid = 22972056 | pmc = 7061650 | doi = 10.1002/14651858.cd001901.pub2 | author3-link = Jane Hutton }}</ref> The patent for the extended release tablet will expire in 2028.<ref>{{Cite web |url=http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2011/091291s000ltr.pdf |title=FDA Access Data |date=12 September 2011 |access-date=4 November 2015 |website=ANDA 091291 |publisher=Department of Health and Human Services |vauthors=Webber K |archive-date=4 March 2016 |archive-url=https://web.archive.org/web/20160304063413/http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2011/091291s000ltr.pdf |url-status=live }}</ref>

The branded version Keppra is manufactured by [[UCB (company)|UCB Pharmaceuticals IncS.A.]]<ref name="Keppra SmPC" /><ref name="Keppra tablet FDA label" /><ref name="Keppra XR FDA label" /><ref name="Keppra IV FDA label" />

In 2015, Aprecia's [[3D printing|3D-printed]] [[orally disintegrating tablet]] form of the drug manufactured using [[3D printed medication|pharmaceutical 3D printing techniques]] was approved by the [[FDA]], under the trade name Spritam.<ref>{{cite web |title=FDA approves the first 3D-printed drug product |url=http://www.kurzweilai.net/fda-approves-the-first-3d-printed-drug-product |website=KurzweilAI |access-date=2015-10-14 October 2015 |date=13 October 2015 |archive-date=16 October 2015 |archive-url=https://web.archive.org/web/20151016233809/http://www.kurzweilai.net/fda-approves-the-first-3d-printed-drug-product |url-status=live }}</ref> Some have said that the drug has been improved by 3D printing, as the formula used now has improved disintegration properties.<ref>{{Cite journal | vauthors = Mohammed AA, Algahtani MS, Ahmad MZ, Ahmad J, Kotta S |date=1 December 2021-12-01 |title=3D Printing in medicine: Technology overview and drug delivery applications |journal=Annals of 3D Printed Medicine |series=3D-Printed Medicine: From today's accomplishments to tomorrow's promises |language=en |volume=4 |pages=100037 |doi=10.1016/j.stlm.2021.100037 |s2cid=244421616 |issn=2666-9641|doi-access=free }}</ref>

Levetiracetam ishas beingbeen looked atstudied in psychiatricthe andpast for treating symptoms of neurologicneurobiological conditions such as [[Tourette syndrome]],<ref>{{cite journal | vauthors = Martínez-Granero MA, García-Pérez A, Montañes F | title = Levetiracetam as an alternative therapy for Tourette syndrome | journal = Neuropsychiatric Disease and Treatment | volume = 6 | pages = 309–316 | date = June 2010 | pmid = 20628631 | pmc = 2898169 | doi = 10.2147/ndt.s6371 | doi-access = free }}</ref> and [[anxiety disorder]].<ref name="Farooq">{{cite journal | vauthors = Farooq MU, Bhatt A, Majid A, Gupta R, Khasnis A, Kassab MY | title = Levetiracetam for managing neurologic and psychiatric disorders | journal = American Journal of Health-System Pharmacy | volume = 66 | issue = 6 | pages = 541–561 | date = March 2009 | pmid = 19265183 | doi = 10.2146/ajhp070607 }}</ref> However, its most serious adverse effects are behavioral, and its benefit-risk ratio in these conditions is not well understood.<ref name="Farooq" />