THERAPEUTICS

Brands

• Keppra, Kopodex, Keppra XR

Generic?

• Yes

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Adjunctive therapy for partial seizure (≥ 1 month of age), myoclonic seizure (≥ 12 years of age), and primary general tonic-clonic seizures (≥ 6 years of age)

• Status epilepticus

• Headache prophylaxis

• Seizure prophylaxis after severe traumatic brain injury

• Mania

How the Drug Works

• Binds to synaptic vesicle protein isoform SV2A in the brain, a unique mechanism of action compared with other AEDs. SV2A is involved in synaptic vesicle exocytosis

• Does not appear to affect GABA transmission, sodium channel or potassium channel function. Modulation of N-type calcium and glycine-gated currents

• Effective in rat kindling models

How Long Until It Works

• Seizures: effective within 48 hours at starting dose, and should reduce seizures by 2 weeks

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy

• Headache/pain: goal is a 50% or greater decrease in frequency or severity

If It Doesn't Work

• Increase to highest tolerated dose

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Epilepsy: commonly used in combination with other AEDs

Tests

• No regular blood tests are recommended

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• CNS AEs are probably caused by effects on SV2A synaptic vesicle proteins

Notable AEs

• Sedation, asthenia, nausea, dizziness, headache

• Behavioral symptoms: agitation, hostility, emotional lability, and depression. More common when used in combination with other AEDs or history of a preexisting behavioral disorder

Life-Threatening or Dangerous AEs

• Rare psychotic symptoms or suicidal ideation

Weight Gain

• Unusual