Levetiracetam Neuraxpharm (Levetiracetam)

Levetiracetam is an antiepileptic drug that acts on neuronal excitability to control various seizure types.

• Partial seizures: Reduces frequency and severity of focal onset seizures.
• Generalized tonic‑clonic seizures: Controls bilateral convulsive episodes in patients with epilepsy.
• Myoclonic seizures: Decreases rapid, involuntary muscle jerks associated with myoclonic epilepsy.

• Levetiracetam binds selectively to the synaptic vesicle protein SV2A, a key regulator of neurotransmitter release. This interaction modulates calcium‑dependent exocytosis, stabilizing synaptic transmission and reducing hyper‑excitability of neuronal networks. By influencing the release of glutamate and GABA, levetiracetam helps to prevent the rapid, synchronized firing that underlies epileptic seizures. The downstream effects are not fully understood, but SV2A binding results in a net anticonvulsant effect without interaction with ion channels or receptors commonly targeted by other antiepileptic agents.

Levetiracetam may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Dizziness: Sensation of light‑headedness or imbalance.
• Fatigue: Generalized tiredness or lack of energy.
• Somnolence: Increased sleepiness during the day.
• Irritability: Mood changes including agitation.
• Headache: Mild to moderate head pain.
• Nausea: Upset stomach or feeling of queasiness.

Serious or Rare Side Effects

• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Suicidal thoughts: New or worsening depression or suicidal ideation.
• Blood disorders: Agranulocytosis, neutropenia, or thrombocytopenia.
• Multi‑organ failure: Rare systemic hypersensitivity reactions.
• Hepatic injury: Uncommon liver enzyme elevations or hepatitis.

When prescribing levetiracetam, clinicians should consider several precautionary measures to ensure safe use.

• Renal function: Assess and adjust dose in patients with impaired renal clearance.
• Psychiatric history: Monitor for mood changes, depression, or suicidal ideation.
• Discontinuation: Avoid abrupt cessation; taper gradually under medical supervision.
• Pregnancy: Use only if benefit outweighs potential risk, as safety data are limited.
• Concomitant CNS depressants: Use caution when combined with alcohol or other sedatives.
• Store below 25°C: Keep in original packaging, protect from moisture and direct sunlight.

Levetiracetam can interact with other medicines, influencing its plasma concentration or enhancing central nervous system effects.

Major Interactions (Avoid)

• Carbamazepine: Enzyme inducer that can lower levetiracetam levels.
• Phenytoin: Reduces levetiracetam exposure through hepatic induction.
• Phenobarbital: Decreases levetiracetam concentrations via enzyme induction.

Moderate Interactions (Monitor Closely)

• Alcohol: May increase sedation and dizziness.
• Other CNS depressants: Combined effect can enhance drowsiness.
• Oral contraceptives: Possible reduction in contraceptive efficacy.
• Antidepressants: May potentiate mood changes.