What are the uses of Levipil (Levetiracetam)?

Uses of Levipil (Levetiracetam)

Levetiracetam (Levipil) is primarily indicated as adjunctive therapy for three main types of seizures: partial onset seizures in patients 4 years and older, myoclonic seizures in patients 12 years and older with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients 6 years and older with idiopathic generalized epilepsy. 1

FDA-Approved Indications

1. Partial Onset Seizures

• Adults (16 years and older):

  • Initial dose: 1000 mg/day (500 mg BID)
  • Titration: Increase by 1000 mg/day every 2 weeks
  • Maximum recommended dose: 3000 mg/day
  • Success rate: 44-73% 2

• Children (4 to <16 years):

  • Initial dose: 20 mg/kg/day in 2 divided doses
  • Titration: Increase by 20 mg/kg every 2 weeks
  • Target dose: 60 mg/kg/day (30 mg/kg BID)
  • Weight-based dosing available for tablets or oral solution 1

2. Myoclonic Seizures

• Patients 12 years and older with juvenile myoclonic epilepsy:
  • Initial dose: 1000 mg/day (500 mg BID)
  • Titration: Increase by 1000 mg/day every 2 weeks
  • Recommended dose: 3000 mg/day 1

3. Primary Generalized Tonic-Clonic Seizures

• Adults (16 years and older):

  • Initial dose: 1000 mg/day (500 mg BID)
  • Titration: Increase by 1000 mg/day every 2 weeks
  • Recommended dose: 3000 mg/day 1

• Children (6 to <16 years):

  • Initial dose: 20 mg/kg/day in 2 divided doses
  • Titration: Increase by 20 mg/kg every 2 weeks
  • Target dose: 60 mg/kg/day (30 mg/kg BID) 1

Clinical Advantages of Levetiracetam

Safety Profile

• Minimal adverse effects compared to other antiepileptic drugs 2
• No clinically significant pharmacokinetic interactions with other drugs 3
• Lacks cytochrome P450 isoenzyme-inducing potential 3
• Not associated with cognitive impairment or drug-induced weight gain 3

Pharmacokinetic Properties

• Rapid and complete absorption
• High oral bioavailability
• Minimal metabolism
• Primarily renal elimination 3

Administration and Formulations

• Can be administered with or without food 1
• Available as:
  • Immediate-release tablets
  • Oral solution
  • Extended-release once-daily tablets
  • Intravenous infusion 4

Clinical Considerations

Efficacy

• In status epilepticus, levetiracetam has a success rate of 44-73% 2
• For refractory partial seizures, levetiracetam significantly reduces seizure frequency compared to placebo 5
• Improves health-related quality of life measures compared to placebo 3

Adverse Effects

• Most common adverse events are CNS-related:
  • Somnolence
  • Asthenia
  • Headache
  • Dizziness 5
• Behavioral adverse effects may occur in some patients 3
• Most adverse events are mild to moderate in severity 3

Special Populations

• Maintenance dose for status epilepticus: 15 mg/kg (maximum 1,500 mg) IV every 12 hours 2
• For patients already on levetiracetam who continue to experience seizures, adding valproate or fosphenytoin as second-line agents should be considered 2

Emerging Uses

While not FDA-approved for these indications, preliminary evidence suggests potential benefits in:

• Anxiety disorders
• Panic disorder
• Stress-related conditions
• Mood and bipolar disorders
• Autism
• Tourette's syndrome 6

However, use in these non-epileptic conditions is not recommended until more data from larger trials become available 6.