From the Guidelines
The best substitute for Keppra (levetiracetam) is valproate, as it has been shown to be at least as effective as phenytoin for refractory status epilepticus, with potentially fewer adverse effects, as demonstrated in a Class II study by Misra et al 1. When considering alternatives to Keppra, it's essential to evaluate the specific seizure type and individual patient factors.
- Common alternatives include Lamictal (lamotrigine), Trileptal (oxcarbazepine), or Vimpat (lacosamide), which work through different mechanisms but can effectively control seizures for many patients.
- Valproate has been recommended for both emergent treatment of seizures and refractory status epilepticus based on high-level evidence, as stated by the Neurocritical Care Society’s Status Epilepticus Guideline Writing Committee 1.
- The dose of valproate can be 20 to 30 mg/kg at a rate of 40 mg/min, as indicated in the study by Agarwal et al 1.
- It's crucial to consult with a neurologist before making any changes, as abrupt discontinuation of anti-seizure medication can trigger severe seizures.
- Side effect profiles differ between medications - while Keppra is known for potential mood effects, alternatives like valproate may have different concerns such as dizziness, thrombocytopenia, liver toxicity, or hyperammonemia, as listed in the study by Misra et al 1.
- When switching from Keppra, the substitute should be gradually introduced while Keppra is slowly tapered to prevent breakthrough seizures, typically taking 2-4 weeks depending on the dose.
From the Research
Alternatives to Keppra (Levetiracetam)
The following are potential substitutes for Keppra (levetiracetam) based on available evidence:
- Lamotrigine: Studies have shown that lamotrigine is effective in treating partial onset seizures and generalized tonic-clonic seizures 2, 3.
- Valproate: Valproate is a suitable first-line treatment for individuals with generalized tonic-clonic seizures and may be considered as an alternative to levetiracetam 2, 3.
- Zonisamide: Zonisamide has been shown to be non-inferior to lamotrigine in terms of time to 12-month remission from seizures in patients with focal epilepsy 3.
- Carbamazepine: Carbamazepine is a commonly used antiepileptic drug that may be considered as an alternative to levetiracetam, although it may have a higher risk of adverse effects 2.
Key Considerations
When selecting an alternative to Keppra, the following factors should be considered:
- Efficacy: The effectiveness of the alternative medication in controlling seizures.
- Safety: The potential for adverse effects and interactions with other medications.
- Tolerability: The ability of the patient to tolerate the medication and its side effects.
- Cost: The cost of the alternative medication and its impact on the patient's quality of life.
Specific Patient Populations
For specific patient populations, such as women of childbearing potential, valproate may not be a suitable option due to its teratogenic effects, and alternative medications like lamotrigine or levetiracetam may be preferred 3. In patients with absence epilepsy, levetiracetam may be effective at a relatively low dose, but its efficacy may vary depending on individual patient characteristics 4.