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Levetiracetam

By Rania Gollakner, BS, DVM, MPH

Medications

What is levetiracetam?

Levetiracetam (brand names: Keppra®, Elepsia®, Spritam®) is an anticonvulsant used to treat seizures and epilepsy. In dogs, it is typically used in combination with other anticonvulsants, while in cats, it is used alone or in combination.

Its use in cats, dogs, and horses to treat seizures and epilepsy is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

How is levetiracetam given?

Levetiracetam is given by mouth in the form of a tablet, extended release tablet, liquid oral solution, or an injection that is typically used in the clinic. It may be given with or without food; however, if your pet vomits after dosing on an empty stomach, give future doses with food. Do not crush extended-release tablets. Measure liquid forms carefully. Do not stop this medication abruptly in order to prevent withdrawal seizures.

This medication should take effect within 1 to 2 hours; however, effects may not be visibly obvious and therefore laboratory tests may need to be done to evaluate whether the medication is working.

What if I miss giving my pet the medication?

If you miss a dose, give it when you remember, but if it is close to the time for the next dose, skip the dose you missed and give it at the next scheduled time, and return to the regular dosing schedule. Never give your pet two doses at once or give extra doses.

Are there any potential side effects?

The most common side effects include sleepiness and incoordination in dogs. In cats, a decreased appetite, incoordination, drooling, and sleepiness most commonly occur. Serious side effects include persistent vomiting or sudden changes in behavior.

This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

Do not use this medication in pets that are allergic to it. Use cautiously in pets with kidney disease, or pets that are pregnant or nursing. Do not stop this medication abruptly to prevent withdrawal seizures.

Are there any drug interactions I should be aware of?

The following medications should be used with caution when given with levetiracetam: carbamazepine, central nervous system depressants, methotrexate, nonsteroidal anti-inflammatory drugs (NSAIDs), or phenobarbital.

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.

Is there any monitoring that needs to be done with this medication?

Monitor and document your pet’s seizure activity at home. Your veterinarian may monitor your pet to be sure that the medication is working and may monitor therapeutic blood levels. Routine general bloodwork may be checked regularly (every 6-12 months).

How do I store levetiracetam?

Store the tablets and liquid oral solution at room temperature around 77°F (25°C ); excursions between 59°F and 86°F (15°C and 30°C) are permitted.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.

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