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Published online by Cambridge University Press: 06 October 2020
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
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