Levetiracetam

Levetiracetam is an anticonvulsant medication used to treat seizures in people with epilepsy. It is marketed under the brand name Keppra and is available in generic forms. The exact mechanism of action is not fully understood, but it is thought to modulate neurotransmitter release by binding to the synaptic vesicle protein SV2A, which helps stabilize neuronal firing and reduce seizure activity.

Pharmacokinetics and formulation: Levetiracetam is rapidly absorbed after oral dosing, with high bioavailability and peak blood levels reached in about 1 to 2 hours. It has a relatively modest distribution and a half-life of roughly 6 to 8 hours in adults. The drug is primarily eliminated by the kidneys as unchanged drug, so dose adjustments are needed in renal impairment. It undergoes minimal hepatic metabolism and has a low potential for clinically meaningful drug interactions. It is available in oral tablet and oral solution forms and can be given intravenously, allowing flexibility in outpatient and inpatient settings.

Indications and usage: It is used as an adjunctive therapy for partial-onset seizures in adults and in some pediatric patients, and is employed for other seizure types in selected epilepsy syndromes depending on regulatory approvals. Dosing is individualized and commonly starts at a low amount, then titrates to a maintenance dose that may reach up to high daily totals; pediatric dosing is typically weight-based.

Adverse effects and safety: Common side effects include somnolence, dizziness, and fatigue. Behavioral changes such as irritability, agitation, or mood changes can occur, particularly in younger patients. Rare hypersensitivity reactions and mood disorders have been reported. As with other antiseizure medications, there is a potential for suicidal thoughts or behavior, and patients should be monitored. Levetiracetam is generally well tolerated and may be chosen when other interactions are a concern. While data on pregnancy are supportive, treatment should be guided by clinical benefit and patient counseling, and it is excreted into breast milk.