Levetiracetam

CLINICAL USE

Anti-epileptic agent

DOSE IN NORMAL RENAL FUNCTION

250 mg – 1.5 g twice daily

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :170.2

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :

<10 &nbsp &nbsp &nbsp &nbsp &nbsp :

%Excreted unchanged in urine &nbsp &nbsp : 66 (95% drug + metabolite)

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.5–0.7

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :6–8/25

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

50–79 500–1000 mg twice daily130–49 250–750 mg twice daily1<30 250–500 mg twice daily1

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Likely dialysability. 750 mg loading dose then 500–1000 mg daily

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. 750 mg loading dose then 500–1000 mg once daily

HDF/high flux &nbsp :Dialysed. 750 mg loading dose then 500–1000 mg once daily

CAV/VVHD &nbsp &nbsp &nbsp:Likely dialysability. Dose as in GFR=30–49 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antidepressants: antagonism of anticonvulsant effect (convulsive threshold lowered)

Antimalarials: mefloquine antagonises anticonvulsant effect; chloroquine and hydroxychloroquine occasionally reduce seizure threshold

ADMINISTRATION

Reconstition

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Route

Oral, IV

Rate of Administration

15 minutes

Comments

Dilute in 100 mL sodium chloride or glucose 5%

OTHER INFORMATION

51% of the dose is removed with 4 hours of haemodialysisThe inactive metabolite (ucb L057) accumulates in renal failure

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