From the FDA Drug Label
OVERDOSAGE Signs, Symptoms And Laboratory Findings Of Acute Overdosage In Humans The highest known dose of levetiracetam received in the clinical development program was 6000 mg/day. Other than drowsiness, there were no adverse events in the few known cases of overdose in clinical trials Cases of somnolence, agitation, aggression, depressed level of consciousness, respiratory depression and coma were observed with levetiracetam overdoses in postmarketing use. Treatment Or Management Of Overdose There is no specific antidote for overdose with levetiracetam If indicated, elimination of unabsorbed drug should be attempted by emesis or gastric lavage; usual precautions should be observed to maintain airway. General supportive care of the patient is indicated including monitoring of vital signs and observation of the patient's clinical status A Certified Poison Control Center should be contacted for up to date information on the management of overdose with levetiracetam. Hemodialysis Standard hemodialysis procedures result in significant clearance of levetiracetam (approximately 50% in 4 hours) and should be considered in cases of overdose Although hemodialysis has not been performed in the few known cases of overdose, it may be indicated by the patient's clinical state or in patients with significant renal impairment.
The treatment options for Keppra (levetiracetam) toxicity include:
- Elimination of unabsorbed drug by emesis or gastric lavage
- General supportive care, including monitoring of vital signs and observation of the patient's clinical status
- Hemodialysis, which may be indicated in cases of overdose, particularly in patients with significant renal impairment
- Contacting a Certified Poison Control Center for up-to-date information on the management of overdose with levetiracetam 1
From the Research
Treatment of Keppra (levetiracetam) toxicity primarily involves supportive care as there is no specific antidote. Management begins with discontinuation of the medication and monitoring vital signs. Supportive measures include intravenous fluids to maintain hydration and enhance drug elimination, airway protection if consciousness is impaired, and seizure control with benzodiazepines if needed. For severe cases, hemodialysis can effectively remove levetiracetam from the bloodstream, as approximately 50-60% of the drug can be eliminated during a 4-hour dialysis session 2. Activated charcoal may be administered within 1-2 hours of ingestion to reduce absorption. Specific symptoms should be treated accordingly: benzodiazepines for agitation or seizures, antiemetics for nausea and vomiting, and respiratory support if breathing is compromised. Most patients recover completely with supportive care as levetiracetam has a relatively short half-life of 6-8 hours in patients with normal renal function. Close monitoring of renal function is important since the drug is primarily eliminated through the kidneys, and dosage adjustments may be necessary during recovery in patients with kidney impairment.
Key Considerations
- Discontinuation of the medication and monitoring vital signs are crucial steps in managing levetiracetam toxicity.
- Supportive care, including intravenous fluids and airway protection, is essential in severe cases.
- Hemodialysis can be effective in removing levetiracetam from the bloodstream in severe cases.
- Activated charcoal may be administered to reduce absorption.
- Specific symptoms, such as agitation or seizures, should be treated accordingly.
Recent Evidence
A recent study published in 2021 3 compared the clinical effectiveness and cost-effectiveness of lamotrigine, levetiracetam, and zonisamide for focal epilepsy, and valproate and levetiracetam for generalized and unclassified epilepsy. The study found that levetiracetam did not meet the criteria for non-inferiority in the primary intention-to-treat analysis of time to 12-month remission, and was associated with a higher rate of treatment failure and adverse reactions compared to lamotrigine and valproate. However, this study did not specifically address the treatment of levetiracetam toxicity.
Clinical Implications
In clinical practice, the treatment of levetiracetam toxicity should prioritize supportive care and monitoring of vital signs. Hemodialysis and activated charcoal may be considered in severe cases. The choice of treatment should be individualized based on the patient's specific needs and medical history. Close monitoring of renal function is essential, and dosage adjustments may be necessary during recovery in patients with kidney impairment.