Ask your doctor before stopping the medicine. Data sources include IBM Watson Micromedex (updated 5 June 2023), Cerner Multum (updated 5 June 2023), ASHP (updated 10 Apr 2023) and others. The percentage of patients (y-axis) who achieved 50% reduction in weekly seizure rates from baseline in partial onset seizure frequency over the entire randomized treatment period (titration + evaluation period) within the three treatment groups (x-axis) is presented in Figure 1. Levetiracetam (levetiracetam injection) is indicated as adjunctive therapy in the treatment of partial onset seizures in adults and children 1 month of age and older with epilepsy; as adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy; as adjunctive thera. Overview Levetiracetam is rapidly and almost completely absorbed after oral administration. If a smaller volume is required (e.g., pediatric patients), the amount of diluent should be calculated to not exceed a maximum levetiracetam concentration of 15 mg per mL of diluted solution. In controlled clinical studies using an oral formulation of Levetiracetam in adult patients with partial-onset seizures, 15% of Levetiracetam-treated patients reported asthenia, compared to 9% of placebo-treated patients. Somnolence and asthenia occurred most frequently within the first 4 weeks of treatment. No patient was discontinued because of low WBC or neutrophil count. If this happens, do not drive or use tools or machines. A statistically significant difference between Levetiracetam and placebo was observed in Study 5 (see Figure 5). Serious dermatological reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported in both pediatric and adult patients treated with Levetiracetam Injection. The adverse reactions that result from levetiracetam injection use include all of those reported for levetiracetam tablets and oral solution. Read more 5 WARNINGS AND PRECAUTIONS Reactions have included anaphylaxis and angioedema [see Warnings and Precautions (5.3)]. Queens of the Stone Age will bring Phantogram, Viagra Boys, the Armed, and Savages' Jehnny Beth on their fall North American tour. Valproate Levetiracetam Injection (1500 mg twice daily) did not alter the pharmacokinetics of valproate in healthy volunteers. Levetiracetam may cause serious side effects. Roweepra and Keppra may be used in children as young as 1 month old. Levetiracetam Injection is for intravenous use only as an alternative for patients when oral administration is temporarily not feasible. Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Coadministration of this oral contraceptive did not influence the pharmacokinetics of levetiracetam. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Dosing was initiated at a dose of 20 mg/kg/day in two divided doses. In the placebo-controlled study using Levetiracetam tablets in patients with JME 8% of patients receiving Levetiracetam and 2% receiving placebo either discontinued or had a dose reduction as a result of an adverse reaction. The treatment effect associated with Levetiracetam was consistent across age groups. Feeling sick or being sick (nausea or vomiting) Serious side effects Tell a doctor or contact 111 straight away if you have a serious side effect, including: fits or seizures getting worse passing very little pee, feeling tired or confused, or having swollen legs, ankles or feet - these could be signs of kidney problems BSA subject (m2). Equivalent doses of intravenous (IV) levetiracetam and oral levetiracetam result in equivalent Cmax, Cmin, and total systemic exposure to levetiracetam when the IV levetiracetam is administered as a 15-minute infusion. Metabolism Levetiracetam is not extensively metabolized in humans. Can I switch to a different medicine? If you do not have a syringe, ask your pharmacist for one. A child's dose needs may change if the child gains or loses weight. Specific Populations Elderly Pharmacokinetics of levetiracetam were evaluated in 16 elderly subjects (age 61-88 years) with creatinine clearance ranging from 30 to 74 mL/min. Levetiracetam Injection is indicated for the treatment of partial-onset seizures in patients 1 month of age and older. 7 Similarly, levetiracetam has been shown in vitro to inhibit N-type calcium channels. There was no evidence of maternal toxicity. Levetiracetam Injection is for intravenous use only and should be diluted in 100 mL of a compatible diluent prior to administration. Table 3 lists adverse reactions that occurred in at least 1% of adult epilepsy patients receiving Levetiracetam tablets in placebo-controlled studies and were numerically more common than in patients treated with placebo. Increase the daily dose in 2 weeks by an increment of 20 mg/kg to the recommended daily dose of 50 mg/kg (25 mg/kg twice daily). After a prospective baseline period of 12 weeks, patients were randomized to one of two treatment groups described above. Having a seizure during pregnancy could harm both mother and baby. In controlled clinical studies using an oral formulation of Levetiracetam in adult patients with partial-onset seizures, 15% of Levetiracetam-treated patients reported somnolence, compared to 8% of placebo-treated patients. Table 7 lists adverse reactions that occurred in at least 5% of juvenile myoclonic epilepsy patients experiencing myoclonic seizures treated with Levetiracetam tablets and were numerically more common than in patients treated with placebo. Patients enrolled in Study 3 had refractory partial onset seizures for at least 1 year and had taken one classical AED. The pharmacokinetics of levetiracetam are similar when used as monotherapy or as adjunctive therapy for the treatment of partial-onset seizures. In the placebo-controlled study, 5% of patients receiving Levetiracetam and 8% receiving placebo either discontinued or had a dose reduction during the treatment period as a result of an adverse reaction. There are insufficient data to support a statement regarding the distribution of adverse reactions by age and race. Patients enrolled in Study 1 or Study 2 had refractory partial onset seizures for at least two years and had taken two or more classical AEDs. The following adverse reactions have been reported in patients receiving Levetiracetam Injection worldwide. The adverse reactions that led to discontinuation or dose reduction and that occurred more frequently in Levetiracetam-treated patients than in placebo-treated patients are presented in Table 8. How to use. Download Bissoy App to talk Doctor online. The most common adverse reactions in pediatric patients receiving Levetiracetam in combination with other AEDs, for events with rates greater than placebo, were fatigue, aggression, nasal congestion, decreased appetite, and irritability. Levetiracetam Injection is indicated as adjunctive therapy for the treatment of primary generalized tonic-clonic seizures in patients 6 years of age and older with idiopathic generalized epilepsy. Percent reduction in partial seizure frequency over placebo, Percentage reduction in PGTC seizure frequency, analysis(72572-360), label(72572-360), manufacture(72572-360), pack(72572-360), Behavioral Abnormalities and Psychotic Symptoms. The safety and effectiveness of Levetiracetam Injection as adjunctive therapy for the treatment of primary generalized tonic-clonic seizures in pediatric patients 6 years of age and older with idiopathic generalized epilepsy have been established [see Clinical Studies (14.3)]. It comes as tablets, a liquid and granules. Encourage patients to enroll in the North American Antiepileptic Drug (NAAED) pregnancy registry if they become pregnant [see Use In Specific Populations (8.1)]. Levetiracetam Injection is contraindicated in patients with a hypersensitivity to levetiracetam. 4 CONTRAINDICATIONS Levetiracetam is contraindicated in patients with a hypersensitivity to levetiracetam - . The AUC(0-12) at steady-state was equivalent to AUCinf following an equivalent single dose. Levetiracetam is an antiepileptic drug with unique mechanism of action in epilepsy. Patients should be monitored for somnolence and fatigue, and be advised not to drive or operate machinery until they have gained sufficient experience on Levetiracetam Injection to gauge whether it adversely affects their ability to drive or operate machinery. Secondary outcome variables included the responder rate (incidence of patients with 50% reduction from baseline in partial onset seizure frequency). Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling). Randomization was stratified by age range as follows: 1 month to less than 6 months of age (N=4 treated with Levetiracetam), 6 months to less than 1 year of age (N=8 treated with Levetiracetam), 1 year to less than 2 years of age (N=20 treated with Levetiracetam), and 2 years to less than 4 years of age (N=28 treated with Levetiracetam). An analysis of the CBCL/6-18 indicated, on average, a worsening in Levetiracetam Injection-treated patients in aggressive behavior, one of the eight syndrome scores [see Warnings and Precautions (5.1)]. Store at room temperature away from moisture, heat, and light. Detailed Levetiracetam dosage information. General supportive care of the patient is indicated including monitoring of vital signs and observation of the patients clinical status. There was no evidence of maternal toxicity. Find out how levetiracetam treats epilepsy, and how to take it. Consideration should also be given to the total daily fluid intake of the patient. There was no adverse reaction that resulted in discontinuation for more than one patient. Pediatric Patients 1 Month to < 6 Months There are no data to support the physical compatibility of Levetiracetam Injection with antiepileptic drugs that are not listed above. Following oral administration of twice-daily dosing for 10 days, total body clearance decreased by 38% and the half-life was 2.5 hours longer in the elderly compared to healthy adults. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Figure 3: Responder Rate (50% Reduction from Baseline) in Study 3, Effectiveness in Partial-Onset Seizures in Pediatric Patients 4 Years to 16 Years of Age. It is very soluble in water (104.0 g/100 mL). Figure 6: Responder Rate (50% Reduction from Baseline) Oral administration of levetiracetam (0, 70, 350, or 1800 mg/kg/day) to female rats throughout pregnancy and lactation led to an increased incidence of fetal skeletal variations, reduced fetal body weight, and decreased growth in offspring at the mid and high doses and increased pup mortality and neurobehavioral alterations in offspring at the highest dose tested. Psychiatric Reactions and Changes in Behavior. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. In the controlled clinical study that included patients 4 years of age and older with PGTC seizures, the most common adverse reaction in patients receiving Levetiracetam oral formulation in combination with other AEDs, for events with rates greater than placebo was nasopharyngitis. 500 mg per 5 mL In these studies, either Levetiracetam or placebo was added to concurrent AED therapy. Levetiracetam 250mg tablets A A H Pharmaceuticals Ltd Show Cautionary and advisory labels. 4 Years to < 16 Years In patients with severe hepatic impairment (Child-Pugh C), total body clearance was 50% that of normal subjects, but decreased renal clearance accounted for most of the decrease. Do not swallow until the tablet has completely dissolved on your tongue. During the treatment period, Levetiracetam doses were adjusted in 20 mg/kg/day increments, at 2-week intervals to the target dose of 60 mg/kg/day. ( 50% Reduction from Baseline) in Study 5. Levetiracetam Levetiracetam is used alone and along with other medications to control partial-onset seizures (seizures that involve only one part of the brain) in adults, children, and infants 1 month of age or older. In a randomized, double-blind, placebo-controlled study to assess the neurocognitive and behavioral effects of an oral formulation of Levetiracetam as adjunctive therapy in pediatric patients (4 to 16 years of age), 5 patients (8.6%) in the Levetiracetam-treated group and two patients (6.1%) in the placebo-treated group had high eosinophil count values that were possibly clinically significant (10% or 0.7X109/L). Renal clearance of ucb L057 in the presence of probenecid decreased 60%, probably related to competitive inhibition of tubular secretion of ucb L057. It is supplied in single-dose 5 mL vials containing 500 mg levetiracetam, water for injection, 45 mg sodium chloride, and buffered at approximately pH 5.5 with glacial acetic acid and 8.2 mg sodium acetate trihydrate. A complete blood count is recommended in patients experiencing significant weakness, pyrexia, recurrent infections, or coagulation disorders. Study 5 was a multicenter, randomized double-blind, placebo-controlled study, in pediatric patients 1 month to less than 4 years of age with partial seizures, uncontrolled by standard epileptic drugs (AEDs). The background risk of major birth defects and miscarriage for the indicated population is unknown. The following calculation should be used to determine the appropriate daily dose of Levetiracetam Injection for pediatric patients: Daily dose (mg/kg/day) x patient weight (kg). The 18-week treatment period consisted of a 6-week titration period, followed by a 12-week fixed dose evaluation period, during which concomitant AED regimens were held constant. (2833) The concentrate must be diluted before administration. Levetiracetam Injection is an antiepileptic drug available as a clear, colorless, sterile solution (100 mg/mL) for intravenous administration. Can I get epilepsy medicines for free? Physiological changes during pregnancy may affect levetiracetam concentration. Must Be Diluted Prior To You can swallow levetiracetam granules straight from the packet or mix them with food or water. Lehi, Utah 84043, Manufactured by: Hikma Farmacutica (Portugal), S.A. Dose adjustments may be necessary to maintain clinical response. Figure 1: Responder Rate (50% Reduction from Baseline) in Study 1, * statistically significant versus placebo. (2834) In animal studies, levetiracetam produced developmental toxicity (increased embryofetal and offspring mortality, increased incidences of fetal structural abnormalities, decreased embryofetal and offspring growth, neurobehavioral alterations in offspring) at doses similar to human therapeutic doses [see Animal Data]. Initiate treatment with a daily dose of 14 mg/kg in 2 divided doses (7 mg/kg twice daily). Two minor metabolites were identified as the product of hydroxylation of the 2-oxo-pyrrolidine ring (2% of dose) and opening of the 2-oxo-pyrrolidine ring in position 5 (1% of dose). Your doctor may occasionally change your dose. in PGTC Seizure Frequency per Week in Study 7, Placebo (N=84) Levetiracetam (N=79) Pediatric Patients 4 Years to <16 Years The adverse reaction data presented below was obtained from a pooled analysis of two controlled pediatric clinical studies using an oral formulation in pediatric patients 4 to 16 years of age with partial onset seizures. It has the following structural formula: Levetiracetam is a white to off-white crystalline powder with a faint odor and a bitter taste. Study 5 consisted of a 5-day evaluation period, which included a 1-day titration period followed by a 4-day maintenance period. Do not swallow or chew a Spritam dispersible tablet for oral suspension. If a patient cannot tolerate a daily dose of 50 mg/kg, the daily dose may be reduced. 8 Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function [see Clinical Pharmacology (12.3)]. The Achenbach Child Behavior Checklist (CBCL/6-18), a standardized validated tool used to assess a childs competencies and behavioral/emotional problems, was also assessed in this study. Levetiracetam injection is given in a vein if you are unable to take the medicine by mouth. 4 CONTRAINDICATIONS Levetiracetam Injection is contraindicated in patients with a hypersensitivity to levetiracetam. Any unused portion of the Levetiracetam Injection vial contents should be discarded. 6 Months to < 4 Years Hematologic abnormalities occurred in clinical trials and included decreases in white blood cell (WBC), neutrophil, and red blood cells counts (RBC); decreases in hemoglobin and hematocrit; and increases in eosinophil counts. No overall differences in safety were observed between these subjects and younger subjects. The first period of the study (Period A) was designed to be analyzed as a parallel-group study. LEV was extensively investigated in randomized controlled trials and has a very promising efficacy both in focal and generalized epilepsies. Gender Levetiracetam Cmax and AUC were 20% higher in women (N=11) compared to men (N=12). The major metabolic pathway of levetiracetam (24% of dose) is an enzymatic hydrolysis of the acetamide group. The mean decreases from baseline in the Levetiracetam-treated group were -0.4 109/L and -0.3 109/L, respectively, whereas there were small increases in the placebo group. Primary Generalized Tonic-Clonic Seizures Although the pattern of adverse reactions in this study seems somewhat different from that seen in patients with partial seizures, this is likely due to the much smaller number of patients in this study compared to partial seizure studies. Therefore, other controlled pediatric data, presented above, should also be considered to apply to this age group. The median time of onset is reported to be 14 to 17 days, but cases have been reported at least four months after initiation of treatment. Prolonged experience with Levetiracetam Injection in pregnant women has not identified a drug-associated risk of major birth defects or miscarriage, based on published literature, which includes data from pregnancy registries, and reflects experience over two decades [see Human Data]. The no-effect dose for adverse effects on pre-and postnatal development in rats (70 mg/kg/day) is less than the MRHD on a mg/m2 basis. The tour begins on Aug. 3 in Sterling . Key facts Photo: Andreas Neumann. In the clinical trial, the mean daily dose was 47 mg/kg in this age group. In general, the incidences of somnolence and fatigue in the pediatric partial-onset seizure studies, and in pediatric and adult myoclonic and primary generalized tonic-clonic studies were comparable to those of the adult partial-onset seizure studies. Initiate treatment with a dose of 1000 mg/day, given as twice-daily dosing (500 mg twice daily). Dosage adjustment is recommended for patients with impaired renal function and supplemental doses should be given to patients after dialysis [see Dosage and Administration (2.7)]. Study drug was given in two divided doses. Levetiracetam Injection can cause hematologic abnormalities. Tell your doctor about all other medicines you use. Figure 2: Responder Rate (50% Reduction from Baseline) in Study 2: Period A. Yes No 2 DOSAGE AND ADMINISTRATION 2.1 Dosing for Partial-Onset Seizures The recommended dosing for monotherapy and adjunctive therapy is the same as outlined below. Physiological changes may gradually decrease plasma levels of levetiracetam throughout pregnancy. The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied. Levetiracetam half-life in pediatric patients 1 month to < 4 years with epilepsy was shorter (5.3 h) than in adults (7.2 h), and apparent clearance (1.5 mL/min/kg) was faster than in adults (0.96 mL/min/kg). A randomized, double-blind, placebo-controlled study was performed to assess the neurocognitive and behavioral effects of an oral formulation of Levetiracetam as adjunctive therapy in pediatric patients (4 to 16 years of age). As with most antiepileptic drugs, Levetiracetam Injection should generally be withdrawn gradually because of the risk of increased seizure frequency and status epilepticus. In controlled clinical studies using an oral formulation of Levetiracetam in adult patients with partial-onset seizures, minor but statistically significant decreases compared to placebo in total mean RBC (0.03 x 106/mm3), mean hemoglobin (0.09 g/dL), and mean hematocrit (0.38%), were seen in Levetiracetam-treated patients. Estrada do Rio da M, 8, 8A e 8B Fervena - 2705-906 Terrugem SNT, Portugal, NDC 72572-360-01 Rx Only The results of the analysis of Study 1 are displayed in Table 10. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of levetiracetam on the baby. These data indicate that levetiracetam does not influence the plasma concentration of other AEDs and that these AEDs do not influence the pharmacokinetics of levetiracetam. It is demonstrated that levetiracetam 1500 mg intravenous infusion is equivalent to levetiracetam 3 x 500 mg oral tablets. The primary measure of efficacy was the responder rate (percent of patients with 50% reduction from baseline in average daily partial onset seizure frequency) assessed by a blinded central reader using a 48-hour video EEG performed during the last two days of the 4-day maintenance period. 2 DOSAGE AND ADMINISTRATION It is freely soluble in chloroform (65.3 g/100 mL) and in The major metabolite is inactive in animal seizure models. Spritam is for children at least 4 years old who weigh at least 44 pounds (20 kilograms). The primary measure of efficacy was a between group comparison of the percent reduction in weekly partial seizure frequency relative to placebo over the entire 14-week randomized treatment period (titration + evaluation period). Prothrombin time was not affected by levetiracetam. 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