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To determine the concentration of levetiracetam in the blood to establish an individualized dose; to detect toxicity or verify that you are taking the medication as prescribed (compliance); to monitor during health changes that may affect drug clearance and/or kidney function
Initially when establishing dosage; when indicated to detect low or excessive (potentially toxic) concentrations; when you have decreased kidney function; sometimes to verify compliance
A blood sample drawn from a vein in your arm, typically just before your next dose
Levetiracetam is a drug that is used to treat certain seizure disorders (epilepsy) such as: juvenile myoclonic epilepsy, temporal lobe epilepsy, complex partial seizures, myoclonic seizures, refractory seizures, secondarily generalized seizures, simple partial seizures, tonic-clonic seizures. The drug is prescribed as a secondary (adjunctive) treatment in combination with other antiepileptic drugs. This test measures the amount of levetiracetam in the blood.
Epilepsy affects the brain's ability to transmit electrical impulses and to regulate nerve activity. During a seizure, a person may experience changes in consciousness, alterations in sight, smell, and taste, and may experience convulsions. The frequency of seizures varies from a single episode, to occasional seizures, to recurrent seizures. Seizures are categorized by the parts of the brain and body that are affected. Levetiracetam is prescribed to help prevent specific types of recurrent seizures.
Levetiracetam is one of several newer second-generation antiepileptic drugs. It has a wider therapeutic range than many existing first-generation seizure medications. That is, the range of concentration in the blood in which the drug is effective without being toxic is broader, making it somewhat safer. It is also associated with fewer severe side effects and does not interact with as many other drugs. Levetiracetam provides a combination of efficacy and safety that is superior to other treatment choices in many clinical circumstances.
Because levetiracetam has a wider therapeutic range, it does not need to be monitored in the same manner as first-generation antiepileptic drugs. (For further discussion of this, see the article on Therapeutic Drug Monitoring.)
At the start of therapy, doses of levetiracetam may be gradually increased until a standard amount is reached. Once a stable dose is achieved, a blood level may be measured to ensure that it is within the therapeutic range. Since levetiracetam is an adjunct (secondary) medication, the healthcare practitioner will consider the effectiveness of both drugs that are prescribed and adjust them as necessary.
This test is used to measure the amount of levetiracetam in the blood to determine whether the level of drug is within the therapeutic range. Initially, the test may be ordered to help establish the appropriate dose for an individual. Since the therapeutic range is relatively wide and not well established, the healthcare practitioner will evaluate the effectiveness of the dose in controlling seizures and the presence and severity of side effects in the individual. Depending on these clinical findings and the results of the blood test, the dose of drug may be adjusted up or down.
Routine periodic monitoring of levetiracetam is usually not required. However, there are circumstances in which it is useful and sometimes necessary to measure blood levels. Some of these include:
A healthcare practitioner may use a levetiracetam test to help evaluate someone who is experiencing side effects or adverse reactions or experiencing a recurrence of seizures or symptoms. In some cases, testing may be ordered to verify that the person is taking the medication as prescribed (compliance).
Levetiracetam tests may occasionally be ordered after a person begins taking the drug and a stable dose is achieved. Additional levetiracetam tests may be ordered when dosages of the drug are changed and sometimes when the treated person starts or stops taking additional medications in order to judge their effect, if any, on the levetiracetam level.
Tests may be ordered periodically when a person has decreased kidney function, has an underlying condition that may affect kidney function, and/or has significant liver dysfunction.
It may be ordered when a person does not appear to be responding to therapy and has a recurrence of seizures. The blood level may not be high enough, the person may not be taking the medication as prescribed, or the drug may be ineffective for that person.
Levetiracetam tests may also be ordered when a person experiences a troublesome level of side effects and/or develops complications. Side effects that may be seen at any dose but that are related to higher concentrations include:
People who take levetiracetam should talk to their healthcare practitioner about the timing of the sample collection. Often, the recommended time is just before the next dose is taken (trough level).
The therapeutic range for levetiracetam is about 12.0 - 46.0 mcg/mL (mg/L). Levels above 46 mcg/mL are considered potentially toxic. Ranges vary slightly from laboratory to laboratory. Healthcare practitioners and people tested should use the therapeutic ranges and units established by the laboratory that performs the testing. Toxic levels have not been well established. Therapeutic ranges are based on the specimen immediately before the next dose (trough levels).
Within the therapeutic range, most people will respond to the drug without excessive side effects; however, response varies with each individual. Some people will experience seizures at the low end of the therapeutic range, some will experience excessive side effects at the upper end, and some will require dosages outside of the established range for effectiveness and/or freedom from side effects. People who use this medication should work closely with their healthcare practitioner to find the dosage that works the best for them.
In general, if levetiracetam test results are within the therapeutic range (or at an individually established level) and the treated person is not having recurrent seizures and is not experiencing significant side effects, then the drug dosage is considered adequate.
A level that is outside the therapeutic range may mean an individual is not taking the drug as prescribed. This is important to know since this may put the person at increased risk of experiencing symptoms.
People should not increase, decrease, or stop taking their medication without consulting with their healthcare practitioner. Dosage determinations and adjustments must be evaluated on a case-by-case basis.
People who have epilepsy will typically take levetiracetam or other medications throughout their lifetime. If levetiracetam ceases to be effective or causes adverse effects, then the person may need to be given different drug(s).
No, it requires specialized equipment. Blood samples are collected from a vein in the arm and tested in the laboratory.
There are a broad range of AEDs available that have different forms of action and are used to treat different types of seizures. First-generation AEDs that have been use for a long period of time include: phenobarbital (since the early 1900s), phenytoin, carbamazepine, ethosuximide, and valproate (valproic acid). Newer, second-generation AEDs include drugs such as: gabapentin, lamotrigine, oxcarbazepine, topiramate, and levetiracetam. Some of these are used by themselves, but most of the newer AEDs are used in combination with other drugs.
Sources Used in Current Review
2017 review performed by Charbel Abou-Diwan, PhD, DABCC, FACB.
Patsalos PN, Berry DJ, Bourgeois BF, et al. Antiepileptic drugs-best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008 Jul;49(7):1239-1276.
Leppik, I. E. et al. 2002. Effective levetiracetam doses and serum concentrations: Age effects. Epilepsia 43 (Suppl 7):240.
Shih JJ, Whitlock JB, et al. Epilepsy treatment in adults and adolescents: Expert opinion, 2016 Epilepsy & Behavior 2017, Feb 22.
Naik GS, Kodagali R, et al. Therapeutic Drug Monitoring of Levetiracetam and Lamotrigine: Is There a Need? Ther Drug Monit Volume 37, Number 4, August 2015.
Stepanova D, Beran RG. Measurement of levetiracetam drug levels to assist with seizure control and monitoring of drug interactions with other anti-epileptic medications (AEMs). Seizure 23 (2014) 371–376.
Sources Used in Previous Reviews
Cavazos, J. (Updated 2013 March 11). Epilepsy and Seizures. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/1184846-overview. Accessed April 2013.
(© 1995-2013). Levetiracetam, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/83140. Accessed April 2013.
Ochoa, J. and Riche, W. (Updated 2012 October 25). Antiepileptic Drugs. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/1187334-overview. Accessed April 2013.
Johnson-Davis, K. (Reviewed 2013 February). Seizure Disorders – Epilepsy. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/SeizureDis.html?client_ID=LTD#tabs=0. Accessed April 2013.
(Revised 2009 September 1) Levetiracetam. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/druginfo/meds/a699059.html. Accessed April 2013.
Rosenow, F. (2012). Lamotrigine Compared With Levetiracetam in the Initial 26 Weeks of Monotherapy for Focal and Generalised Epilepsy. Medscape News from J Neurol Neurosurg Psychiatry. 2012;83(11):1093-1098. [On-line information]. Available online at http://www.medscape.com/viewarticle/772590. Accessed April 2013.
Ha, H. and Bellanger, R. (2013). Epilepsy: Treatment and Management. Medscape Today News from US Pharmacist. 2013;38(1):35-39 [On-line information]. Available online at http://www.medscape.com/viewarticle/779381. Accessed April 2013.
Buck, M. (2012). Recent Literature on Pediatric Antiepileptic Drugs. Medscape Today News from Pediatr Pharm. 2012;18(12) [On-line information]. Available online at http://www.medscape.com/viewarticle/781121. Accessed April 2013.
Krasowski, M. (2010 May 11). Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications. Pharmaceuticals 2010, 3(6), 1909-1935. [On-line information]. Available online at http://www.mdpi.com/1424-8247/3/6/1909. Accessed April 2013.
Krishna, K. et. al. (2011 October). Levetiracetam. JAPI v 59 [On-line information]. PDF available for download at http://www.japi.org/october_2011/09_dr_levetiracetam.pdf. Accessed April 2013.
(Revised 2013 February). LevETIRAcetam. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merckmanuals.com/professional/lexicomp/levetiracetam.html. Accessed April 2013.
Buck, M. (2012 December 12). Recent Literature on Pediatric Antiepileptic Drugs. Pediatric Pharmacotherapy. A Monthly Newsletter for Health Care Professionals from the University of Virginia Children's Hospital v 18 (12) [On-line information]. PDF available for download through http://www.medicine.virginia.edu. Accessed April 2013.
Groot, M. et. al. (2012). Epilepsy in Patients With a Brain Tumour, Focal Epilepsy Requires Focused Treatment. Brain. V 135(4):1002-1016. [On-line information]. Available online at http://www.medscape.com/viewarticle/763947_1. Accessed April 2013.
St. Louis E. Monitoring Antiepileptic Drugs: A Level-headed Approach. Curr Neuropharmacol. 2009 June; 7(2): 115–119. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730002/. Accessed April 2013.
Krasowski M. Therapeutic Drug Monitoring of the Newer Anti-Epilepsy Medications. Pharmaceuticals (Basel). 2010 June 11; 3(6): 1909–1935. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904466/#R7. Accessed April 2013.