Published: 1 June 2017

Publications

Spotlight on Levetiracetam

Prescriber Update 38(2): 19-20
June 2017

Key Messages

  • Levetiracetam is an antiepileptic medicine used as add-on therapy in the treatment of epilepsy.
  • The major safety concern with use of levetiracetam is an increase in mood disorders including suicidality.
  • Patients, their relatives and friends should be asked to closely monitor for changes in behaviour and to seek immediate medical attention should any changes occur.
  • Monitoring renal function and changes in dose may be required in patients with impaired renal function.


The Prescriber Update survey ran between 3 March 2016 and 8 April 2016. Feedback from this survey indicated that readers would like to see more reviews about the safety of specific medicines and classes of medicines. The first spotlight article will be on levetiracetam.

Levetiracetam is approved as add-on treatment for partial onset seizures with or without secondary generalisation in patients aged six years and older 1,2.

Levetiracetam is an unusual medicine in that almost 100% of the dose is absorbed via the oral route. For this reason, it is generally considered acceptable to change brands without the need for additional monitoring3. However, reactions associated with changing the brand of levetiracetam have been reported to the Centre for Adverse Reactions Monitoring (CARM).

Levetiracetam is excreted renally with around 95% of the dose excreted in the urine. A dose adjustment based on the patient’s creatinine clearance is necessary in patients with moderate to severe renal impairment 1.

The only contraindication for use is hypersensitivity reactions. Levetiracetam must not be used in patients allergic to levetiracetam, other pyrrolidone derivatives or any of the excipients in the medicine. The excipients are listed in the data sheet, Consumer Medicine Information (www.medsafe.govt.nz/Medicines/infoSearch.asp) and in the product application search on the Medsafe website (www.medsafe.govt.nz/regulatory/DbSearch.asp).

All patients who are taking levetiracetam should be closely monitored for changes in behaviour. Psychiatric disorders that have been associated with the use of levetiracetam include aggression, abnormal behaviour, suicide and suicidality 1. Patients, relatives and friends should be encouraged to monitor behaviour and to seek immediate medical advice if changes are noticed. Healthcare professionals are reminded to inform patients and their families and caregivers of the potential risk of suicidality1.

Further information regarding antiepileptic medicines and suicide can be found in previous Prescriber Update articles 4-6.

At 31 December 2016, the Centre for Adverse Reactions Monitoring (CARM) had received 35 reports in which levetiracetam was reported as a suspect medicine. Reaction terms that were reported twice or more include irritability, mood disorder, depression, hyponatraemia, neutropenia, suicidal ideation, vomiting, aggressive reaction and brand switch. All of these potential adverse reactions, excluding brand switch, are listed in the New Zealand data sheet for levetiracetam1,7.

Please continue to report any adverse reactions for levetiracetam and any other medicine to CARM. Reports can be submitted on paper or electronically (https://nzphvc.otago.ac.nz/).

References
  1. REX Medical Limited. 2014. Everet Data Sheet 22 December 2014. URL: medsafe.govt.nz/profs/Datasheet/e/everettab.pdf (accessed 20 April 2017).
  2. New Zealand Formulary. 2017. Levetiracetam. NZF v58 1 April 2017. URL: nzf.org.nz/nzf_2641 (accessed 20 April 2017).
  3. Medicines and Healthcare products Regulatory Agency. 2013. Antiepileptic drugs: new advice on switching between different manufacturers’ products for a particular drug. Drug Safety Update 14 November 2013. URL: gov.uk/drug-safety-update/antiepileptic-drugs-new-advice-on-switching-between-different-manufacturers-products-for-a-particular-drug (accessed 20 April 2017).
  4. 2016. Antiepileptic Medicines and Suicide. Prescriber Update 37(1): 6–7. URL: www.medsafe.govt.nz/profs/PUArticles/March2016/AntilepilepticMedicinesAndSuicide.htm (accessed 20 April 2017).
  5. 2009. Antiepileptic medicines — increased risk of suicidality. Prescriber Update 30(2): 11. URL: www.medsafe.govt.nz/profs/PUArticles/Antiepileptics%20&%20suicidality-May09.htm (accessed 20 April 2017).
  6. 2010. Suicidality — a rare adverse effect. Prescriber Update 31(1): 7. URL: www.medsafe.govt.nz/profs/PUArticles/Suicidality%20-%20a%20rare%20adverse%20effect.htm (accessed 20 April 2017).
  7. Pharmabroker Sales Ltd. 2016. Keppra data sheet 6 May 2016. URL: medsafe.govt.nz/profs/Datasheet/k/Keppratab.pdf (accessed 26 April 2017).
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