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Levetiracetam is a newer anti-epileptic drug that is used in the management of refractory epilepsy in dogs and cats. A pyrridoline derivative, levetiracetam has a number of favorable pharmacokinetic characteristics. It has excellent bioavailability, minimal protein binding and a rapid onset of action. Levetiracetam is not extensively metabolized by the liver, and does not utilize the p450 hepatic-cytochrome system. It may be used in humans or animals with decreased liver function. Levetiracetam is excreted in the urine and there are no known drug interactions.
Levetiracetam is used in humans for partial-onset and
generalized seizures. It may be used as monotherapy or as an add on for
refractory epilepsy. There is some experimental work in humans using intravenous
levetiracetam for refractory status epilepticus.
Levetiracetam is used as an add-on drug for dogs and cats whose seizures are not adequately controlled by phenobarbital or the bromides - as many as 60-70 percent of dogs and cats with epilepsy are not adequately controlled by these medications. Levetiracetam may also be useful in the treatment of seizures due to hepatic encephalopathy or cases of phenobarbital-induced liver damage. The addition of levetiracetam may permit a lower dose of phenobarbital without an increase in seizure frequency.
This is a relatively new drug in veterinary medicine
and there is little long-term information available. There are indications
that some animals may develop a "tolerance" to levetiracetam
and, after the initial honeymoon, the seizure frequency may rebound. Although
it has a relatively short half-life in dogs and cats, the pharmacodynamic
effect is thought to exceed the half-life. Most authors recommend dosing
every eight-hours.
Based on experience in human medicine, levetiracetam
is generally well tolerated. The most likely side effects include changes
in behavior, drowsiness and GI upset. In studies performed with children,
the behavior changes included hyperactivity, somnolence and aggression.
• Levetiracetam has been shown to cause increased
embryonal and fetal losses in laboratory animals. It should only be used
during pregnancy when the benefits outweigh the possible risks.
• Levetiracetam should be used with caution in animals with decreased
kidney function. Adjustments in dose and dose frequency may be necessary.
• When discontinuing use of levetiracetam, a gradual withdrawal is
recommended to guard against the possibility of withdrawal seizures.
• No drug interactions were found in humans or dogs.
• Levetiracetam has wide margin of safety. Dogs given 20 times the normal dose only showed transient GI upset. Treatment following a possible overdose would be primarily supportive.
Dr.
Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania.
She has a master's degree in animal science from the University of Delaware
and graduated from the University of Pennsylvania School of Veterinary Medicine
in 1982.
She began to develop her interest in client education and medical writing 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
You can purchase books by Dr. Forney at www.exclusivelyequine.com
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