Levetiracetam Tablets
Anti-Convulsant
Levetiracetam is has been shown to be useful for treating status epilepticus, and acute repetitive seizures (cluster seizures) in dogs. For refractory epilepsy it can be useful as an add-on drug for dogs that are not well controlled with, or cannot tolerate phenobarbital and bromide. Some evidence suggests that in dogs suffering from phenobarbital liver toxicity, the addition of levetiracetam will allow reduction of their phenobarbital dosage without increasing seizure frequency.
Levetiracetam may also be useful as add-on therapy in cats when phenobarbital does not control seizures or alone in cats that are unable to tolerate phenobarbital.
Preliminary data in horses has demonstrated that it may be efficacious when given orally
Dosage for dogs and cats:
Dogs: Maintenance anticonvulsant
- 7–25 mg/kg orally every 8 hours
- 10–20 mg/kg orally every 8 hours with phenobarbital and potassium bromide for pharmacoresistent dogs
30 mg/kg orally every 12 hours with extended release product
Cats: Maintenance anticonvulsant
- 20mg/kg orally every 8 hours
- 20 mg/kg orally every 8-12 hours
Dogs:
For treatment of refractory epilepsy (extra-label):
Using regular tablets: Based on pharmacokinetic studies and presumed therapeutic levels most recommend 20 mg/kg PO q8h although recommendations up to 30 mg/kg PO q8h have been noted. Some have suggested that because of the drug’s safety, dosages may be increased further until efficacy is achieved, side effects become apparent, or drug cost becomes prohibitive. If using as an add-on to phenobarbital therapy levetiracetem half-life may be shortened and dosage adjustment may be necessary.
Using extended-release tablets: Based upon pharmacokinetic studies in dogs using Keppra XR®: 30 mg/kg PO q12h. Once daily dosing may be acceptable in some dogs, although monitoring is recommended to confirm. Do not split or crush. The smallest extended-release tablet is 500 mg so it cannot be practically dosed in small dogs. (Platt et al. 2011; Beasely et al. 2012)
For status epilepticus or acute repetitive (cluster) seizures (extra-label): Doses of 30 mg/kg or 60 mg/kg IV were effective in 56% of treated dogs. While levetiracetem was safe in these patients and potentially is effective for the treatment of SE and ARS, larger, controlled clinical trials are needed (Hardy et al. 2012). From a single-dose pharmacokinetic study: In normal dogs, a 60 mg/kg IV bolus dose of levetiracetam is well tolerated and achieves plasma drug concentrations within or above the therapeutic range reported for humans for at least 8 hours after administration (Dewey et al. 2008).
For home SC administration in dogs that do not always respond sufficiently to diazepam (per rectum and/or intranasally); (extra-label): 60 mg/kg SC; based on a pilot study in healthy dogs. (Hardy et al. 2011)
Cats:
For epilepsy (extra-label): Based on the drug’s pharmacokinetics in cats and the presumed therapeutic levels for the drug, an initial dose of 20 mg/kg IV, PO q8h should be adequate for most cats. However, for some cats the trough level may be too low and doubling the dose to approximately 40 mg/kg PO q8h be necessary (Carnes et al. 2011). As an add-on to phenobarbital treatment: Initially, 20 mg/kg PO three times daily. Monitor as below. If ineffective, increase dose in 20 mg/kg increments (Bailey et al. 2008), (Bailey et al. 2009).
Monitoring
The therapeutic range for animals has not been specifically determined, but it is thought that it is similar to humans, 5 – 45 micrograms/mL. Because the drug appears to be very safe, therapeutic drug monitoring is used primarily to adjust dosage (Bailey et al. 2009).
Veterinarians should have the owner keep a record of seizure activity to document efficacy and report any potential levetiracetam-associated adverse effects.
Routine CBC, basic metabolic panel every 6 months.
Client Information
May be given with or without food. If your animal vomits or acts sick after getting it on an empty stomach, give with food or small treat to see if this helps. If vomiting continues, contact your veterinarian.
May need to be given three times a day. It may not work if it is given less often.
Lethargy (tiredness; lack of energy) and reduced appetite are the most likely side effects.
Do not crush or allow your pet to chew extended-release tablets.
Side Effects:
Levetiracetam appears to be very well tolerated in dogs and cats. Most common adverse effects reported include sedation and ataxia in dogs and reduced appetite, hypersalivation, and lethargy in cats. These effects may be transient. Changes in behavior, and gastrointestinal effects could occur.
In humans, it is recommended to withdraw the drug slowly to prevent “withdrawal” seizures.
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