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1 tablished for extended-release and injection); OB: Use only if potential benefit justi-
fies potential risk to fetus; blood levels may bepduring pregnancy (especially during
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levetiracetam (le-ve-teer-a-se-tam) 3rd trimester); Geri:prenal elimination (dosepmay be necessary).
Keppra, Keppra XR Adverse Reactions/Side Effects
Classification CNS: SUICIDAL THOUGHTS, aggression, agitation, anger, anxiety, apathy, depersonali-
Therapeutic: anticonvulsants zation, depression, dizziness, hostility, irritability, personality disorder, weakness,
Pharmacologic: pyrrolidines drowsiness, dyskinesia, fatigue. Neuro: coordination difficulties (adults only).
Pregnancy Category C Derm: STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

Indications Interactions
Partial onset seizures (adjunct). Primary generalized tonic-clonic seizures (adjunct) Drug-Drug: None noted.
(immediate-release and injection only). Myoclonic seizures in patients with juvenile Route/Dosage
myoclonic epilepsy (adjunct) (immediate-release and injection only). Only the oral solution should be used in patients ⱕ20 kg.
Action Partial Onset Seizures
Appears to inhibit burst firing without affecting normal neuronal excitability and may
selectively prevent hypersynchronization of epileptiform burst firing and propagation PO, IV (Adults and Children ⱖ16 yr): 500 mg 2 times daily initially; mayqby
of seizure activity. Therapeutic Effects: Decreased incidence and severity of sei- 1000 mg/day at 2-wk intervals up to 3000 mg/day; Extended-release— 1000 mg
zures. daily; mayqby 1000 mg/day at 2– wk intervals up to 3000 mg/day.
PO (Children 4– 15 yr): 10 mg/kg twice daily;qby 20 mg/kg/day at 2-wk intervals
Pharmacokinetics to recommended dose of 30 mg/kg twice daily (maximum dose: 3000 mg/day).
Absorption: Rapidly and completely absorbed following oral administration. PO (Children 6 mo– 3 yr): 10 mg/kg twice daily;qby 20 mg/kg/day at 2-wk inter-
Distribution: Unknown. vals to recommended dose of 25 mg/kg twice daily.
Protein Binding: ⬍10%. PO (Children 1– 5 mo): 7 mg/kg twice daily;qby 14 mg/kg/day at 2-wk intervals to
Metabolism and Excretion: 66% excreted unchanged by the kidneys; some recommended dose of 21 mg/kg twice daily.
metabolism by the liver (metabolites inactive).
Half-life: 7.1 hr (qin renal impairment). Primary Generalized Tonic-Clonic Seizures
TIME/ACTION PROFILE (blood levels) PO, IV (Adults and Children ⱖ16 yr): 500 mg 2 times daily initially;qby 1000
ROUTE ONSET PEAK DURATION mg/day at 2-wk intervals to recommended dose of 3000 mg/day.
PO rapid 1–1.5 hr†‡ 12 hr PO (Children 6– 15 yr): 10 mg/kg twice daily;qby 20 mg/kg/day at 2-wk intervals
to recommended dose of 30 mg/kg 2 times daily.
†1 hr in the fasting state, 1.5 hr when taken with food
‡ 4 hr with extended-release Myoclonic Seizures
Contraindications/Precautions IV (Adults and Children ⱖ16 yr): 500 mg 2 times daily initially;qby 1000 mg/day
Contraindicated in: Hypersensitivity; Lactation: Lactation. at 2-wk intervals to recommended dose of 3000 mg/day.
Use Cautiously in: All patients (mayqrisk of suicidal thoughts/behaviors); Renal PO (Children ⱖ12 yrs): 500 mg twice daily initially;qby 1000 mg/day at 2-wk in-
impairment (doseprecommended if CCr ⱕ80 mL/min); Pedi: ⬍16 yr (safety not es- tervals to recommended dose of 3000 mg/day.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/levetiracetam 02/17/2014 07:02AM
2 Potential Nursing Diagnoses
Status Epilepticus
IV (Infants and Children ⬍ 16yr): 50 mg/kg/dose followed by maintenance dose
of 30– 55 mg/kg/day IV/PO divided BID.
IV (Neonates): 20– 30 mg/kg/dose loading followed by neonatal seizure dosing.
Neonatal Seizures
IV (Neonates): 10 mg/kg/day divided BID;qby 10 mg/kg at 3 day intervals to 30
mg/kg/day. Mayqto 45– 60 mg/kg/day with persistent seizure activity.
PO (Neonates): 10 mg/kg/day in 1– 2 divided doses initially;qdaily by 10 mg/kg up
to 30 mg/kg/day (maximum reported dose: 60 mg/kg/day).
Renal Impairment
PO, IV (Adults): CCr 50– 80 mL/min— 500– 1000 mg q 12 hr (1000– 2000 mg q
24 hr for extended-release); CCr 30– 50 mL/min— 250– 750 mg q 12 hr (500–
1500 mg q 24 hr for extended-release); CCr ⬍30 mL/min— 250– 500 mg q 12 hr
(500– 1000 mg q 24 hr for extended-release); Dialysis (immediate– release and
injection)— 500– 1000 mg q 24 hr with a 250– 500-mg supplemental dose after
dialysis.
NURSING IMPLICATIONS
Assessment
● Assess location, duration, and characteristics of seizure activity.
● Assess patient for CNS adverse effects throughout therapy. These adverse effects
are categorized as somnolence and fatigue (asthenia), coordination difficulties
(ataxia, abnormal gait, or incoordination), and behavioral abnormalities (agita-
tion, hostility, anxiety, apathy, emotional lability, depersonalization, depression)
and usually occur during the first 4 wk of therapy.
● Monitor mood changes. Assess for suicidal tendencies, especially during
early therapy. Restrict amount of drug available to patient.
● Assess for rash periodically during therapy. May cause Stevens-Johnson
syndrome. Discontinue therapy if severe or if accompanied with fever,
general malaise, fatigue, muscle or joint aches, blisters, oral lesions,
conjunctivitis, hepatitis and/or eosinophilia.
● Lab Test Considerations: May causepRBC and WBC and abnormal liver func-
tion tests.
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Risk for injury (Side Effects)
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Implementation
● Do not confuse Keppra (levetiracetam) with Kaletra (lopinavir/ritona-
vir).
● IV doses should be used temporarily when oral route is not feasible. To convert IV
to PO, equivalent dose and frequency may be used.
● PO: May be administered without regard to meals.
● Administer tablets whole; do not administer partial tablets. Do not break, crush, or
chew XR tablets.
● Pedi: Patients ⬍20 kg should receive oral solution. Administer with calibrated
measuring device for accurate dose.
● Discontinue gradually to minimize the risk of increase in seizure frequency.
IV Administration
● Intermittent Infusion: Diluent: Dilute dose in 100 mL of 0.9% NaCl, D5W, or
LR. Do not administer solutions that are cloudy or contain particulate matter.
Rate: Infuse over 15 min.
● Y-Site Compatibility: diazepam, lorazepam, valproate.
Patient/Family Teaching
● Instruct patient to take medication as directed. Pedi: Explain to parents the im-
portance of using calibrated measuring device for accurate dosing. Take missed
doses as soon as possible unless almost time for next dose. Do not double doses.
Do not discontinue abruptly; may cause increase in frequency of seizures. Advise
patient to read the Medication Guide prior to starting therapy and with each Rx
refill in case of changes.
● May cause dizziness and somnolence. Caution patient to avoid driving or activities
requiring alertness until response to medication is known. Do not resume driving
until physician gives clearance based on control of seizure disorder.
● Advise patient and family to notify health care professional if thoughts
about suicide or dying, attempts to commit suicide; new or worse de-
pression; new or worse anxiety; feeling very agitated or restless; panic
attacks; trouble sleeping; new or worse irritability; acting aggressive;
being angry or violent; acting on dangerous impulses; an extreme in-
crease in activity and talking; other unusual changes in behavior or
mood or if skin rash occur.
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levetiracetam
● Advise patient to notify health care professional of all Rx or OTC medications, vita-
mins, or herbal products being taken and to consult with health care professional
before taking other medications.
● Advise female patients to notify health care professional if pregnancy is planned or
suspected or if breast feeding. Encourage pregnant patients to enroll in the North
American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-
2334; information is available at www.aedpregnancyregistry.org.
● Instruct patient to notify health care professional of medication regimen prior to
treatment or surgery.
● Advise patient to carry identification describing disease process and medication
regimen at all times.
Evaluation/Desired Outcomes
● Decrease in the frequency of or cessation of seizures.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.