THERAPEUTICS

Brands

• Keppra
• Keppra XR
• see index for additional brand names

Generic?

• No

Class

• Anticonvulsant, synaptic vesicle protein SV2A modulator

Commonly Prescribed For

• (bold for FDA approved)
• Adjunct therapy for partial seizures in adults with epilepsy (ages 4 and older)
• Adjunct therapy for myoclonic seizures in juvenile myoclonic epilepsy (ages 12 and older)
• Adjunct therapy for primary generalized tonic-clonic seizures in idiopathic generalized epilepsy (ages 6 and older)
• Neuropathic pain/chronic pain
• Mania

How The Drug Works

• Binds to synaptic vesicle protein SV2A, which is involved in synaptic vesicle exocytosis
• Opposes the activity of negative modulators of GABA- and glycine-gated currents and partially inhibits N-type calcium currents in neuronal cells

How Long Until It Works

• Should reduce seizures by 2 weeks
• Not yet clear if it has mood stabilizing effects in bipolar disorder or antineuralgic actions in chronic neuropathic pain, but some patients may respond and if so, would be expected to show clinical effects starting by 2 weeks although it may take several weeks to months to optimize clinical effects

If It Works

• The goal of treatment is complete remission of symptoms (e.g., seizures, mania, pain)
• The goal of treatment of chronic neuropathic pain is to reduce symptoms as much as possible, especially in combination with other treatments
• Treatment of chronic neuropathic pain most often reduces but does not eliminate symptoms and is not a cure since symptoms usually recur after medicine stopped
• Continue treatment until all symptoms are gone or until mood is stable and then continue treating indefinitely as long as improvement persists
• Continue treatment indefinitely to avoid recurrence of seizures, mania, and pain

If It Doesn’t Work (for bipolar disorder or neuropathic pain)

• May be effective in a subset of bipolar patients, in some patients who fail to respond to other mood stabilizers, or it may not work at all
• Many patients have only a partial response where some symptoms are improved but others persist or continue to wax and wane without stabilization of pain or mood
• Other patients may be nonresponders, sometimes called treatment-resistant or treatment-refractory
• Consider increasing dose or switching to another agent with better demonstrated efficacy in bipolar disorder or neuropathic pain

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Levetiracetam is itself a second-line augmenting agent to numerous other anticonvulsants, lithium, and atypical antipsychotics for bipolar disorder and to gabapentin, tiagabine, other anticonvulsants, SNRIs, and tricyclic antidepressants for neuropathic pain

Tests

• None for healthy individuals