From the Guidelines
Levetiracetam oral tablets are indicated for seizure prophylaxis in patients undergoing CAR T-cell therapy, particularly those with large tumor burden and aggressive histologies, at a dose of 500-750 mg orally every 12 hours for 30 days, as recommended by the NCCN clinical practice guidelines in oncology 1.
Indications for Levetiracetam
- Seizure prophylaxis in patients undergoing CAR T-cell therapy
- Treatment of epilepsy and seizure disorders, including partial-onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children
Dosage and Administration
- For seizure prophylaxis in CAR T-cell therapy, 500-750 mg orally every 12 hours for 30 days
- For epilepsy and seizure disorders, treatment typically begins with a low dose, such as 500 mg twice daily for adults, which can be gradually increased based on clinical response to a maximum of 3000 mg daily
- For children, dosing is weight-based, usually starting at 10 mg/kg twice daily
Mechanism of Action and Side Effects
- Levetiracetam works by binding to the synaptic vesicle protein SV2A in the brain, which helps regulate neurotransmitter release and reduces abnormal neuronal firing that leads to seizures
- Common side effects include dizziness, drowsiness, and behavioral changes
- Patients should be monitored for mood changes or suicidal thoughts, particularly when starting therapy
Important Considerations
- Abrupt discontinuation should be avoided as it may increase seizure frequency; instead, the medication should be tapered gradually when stopping treatment
- Baseline neurologic evaluation, including immune effector cell-associated encephalopathy (ICE) scores or Cornell Assessment of Pediatric Delirium (CAPD) scores, is recommended prior to CAR T-cell therapy 1
From the FDA Drug Label
Levetiracetam is indicated as adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. Levetiracetam is indicated as adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy Levetiracetam is indicated as adjunctive therapy in the treatment of primary generalized tonicoclonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy.
The indications to start levetiracetam oral tablet are:
- Partial onset seizures in adults and children 4 years of age and older with epilepsy
- Myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy
- Primary generalized tonicoclonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy 2
From the Research
Indications for Levetiracetam Oral Tablet
The indications for levetiracetam oral tablet are as follows:
- Adjunctive treatment of partial-onset seizures with or without secondary generalization 3, 4, 5, 6
- Monotherapy treatment of partial-onset seizures with or without secondary generalization 3, 4, 5, 6
- Adjunctive treatment of myoclonic seizures associated with juvenile myoclonic epilepsy 4, 5, 6
- Adjunctive treatment of primary generalized tonic-clonic (GTC) seizures associated with idiopathic generalized epilepsy 4, 5, 6
Patient Populations
Levetiracetam oral tablet is indicated for use in various patient populations, including:
- Adults with refractory partial-onset seizures 4, 5
- Pediatric patients with refractory partial-onset seizures 4, 5
- Patients with newly diagnosed partial-onset seizures 4, 5
- Patients with idiopathic generalized epilepsy with myoclonic seizures or GTC seizures 4, 5
Clinical Pharmacology
The clinical pharmacology of levetiracetam has been extensively studied, with a focus on its: