Levetiracetam

This assay tests for levetiracetam, an anticonvulsant medication used to control certain types of seizures in patients with epilepsy.

Levetiracetam is prescribed to help prevent partial onset, myoclonic, and tonic-clonic seizures and is marketed under the trade names Keppra^® and Keppra XR^® (extended release). It has a wider therapeutic range than many existing first-generation seizure medications. It is associated with fewer severe adverse effects and does not interact with as many other drugs. Common adverse effects include weakness, infection, and drowsiness.¹ Some symptoms of toxicity include extreme drowsiness, agitation, aggression, hallucinations, lack of coordination, rash, and numbness, tingling, or burning in the hands or feet.¹

Levetiracetam testing can help optimize dosage, verify adherence, detect toxicity, and monitor the impact of a recent health change affecting drug clearance or kidney function.

Once steady state has been reached, blood specimens can be collected 0.5 to 1 hour before the next oral dose (trough).

Note: steady state is typically reached 2 weeks after onset of treatment. The elimination half-life is 6 to 8 hours in adults with epilepsy, 5 to 7 hours in children with epilepsy, and 10 to 11 hours in elderly volunteers.

The therapeutic range of levetiracetam is generally 12 to 46 µg/mL (mg/L) for trough collections. A trough blood concentration >46 µg/mL may be toxic; however, toxic levels are not well established.² Results should be interpreted in the context of the clinical picture, including evidence of drug effectiveness and/or toxicity.

Most people with blood levels within the therapeutic range will respond to the drug without excessive adverse effects. Individual responses can vary, however, and some patients may require dosages outside of the established range to effectively control seizures and/or limit adverse effects. Dosage is considered adequate if the patient has no recurrent seizures and no significant adverse effects.

A levetiracetam concentration above or below the therapeutic range may indicate that the patient is not taking the drug as prescribed. Additionally, high concentrations may be a sign of impaired renal function, as the drug is cleared through the kidneys.