Instructions for use Logufen film-coated tablets 500 mg blister No. 60
Composition
active ingredient: levetiracetam;
1 film-coated tablet contains 250 mg or 500 mg of levetiracetam;
excipients: corn starch, povidone, croscarmellose sodium, colloidal anhydrous silicon dioxide, magnesium stearate;
film coating:
250 mg tablets: Opadry (II) 85G68918 white (polyvinyl alcohol, titanium dioxide (E 171), talc, polyethylene glycol, lecithin);
500 mg tablets: Opadry (II) 85G52482 yellow (polyvinyl alcohol, talc, titanium dioxide (E 171), polyethylene glycol, lecithin, iron oxide yellow (E 172)).
Dosage form
Film-coated tablets.
Main physicochemical properties:
250 mg tablets: oval, film-coated tablets, white to off-white in color, with a breakline on one side;
500 mg tablets: oval, yellow film-coated tablets with a breakline on one side.
Pharmacotherapeutic group
Antiepileptic drugs. Levetiracetam.
ATX code N03A X14.
Pharmacological properties
Pharmacodynamics.
Levetiracetam is a pyrrolidone derivative (S-enantiomer of alpha-ethyl-2-oxo-1-pyrrolidine-acetamide), and its chemical structure differs from known antiepileptic drugs.
Mechanism of action
The mechanism of action of levetiracetam is not well understood. Based on in vitro and in vivo studies, it is assumed that levetiracetam does not alter the basic characteristics of the nerve cell and normal neurotransmission. In vitro studies have shown that levetiracetam affects intracellular Ca2+ levels by partially inhibiting current through N-type Ca2+ channels and reducing the release of Ca2+ from intracellular depots. It also partially eliminates the inhibition of GABA- and glycine-gated currents caused by the action of zinc and β-carbolines. In addition, in vitro studies, levetiracetam bound to specific sites in rodent brain tissue. The binding site is synaptic vesicle protein 2A, which is involved in vesicle fusion and neurotransmitter release. The affinity (ranked) of levetiracetam and its analogues for synaptic vesicle protein 2A correlated with their anticonvulsant potency in mouse models of audiogenic epilepsy. These results suggest that an interaction between levetiracetam and synaptic vesicle protein 2A may partially explain the mechanism of the drug's antiepileptic action.
Pharmacodynamic effects
Levetiracetam provides protection against seizures in a wide range of partial and primary generalized seizure models in animals without causing proconvulsant effects. The main metabolite is inactive.
In humans, the drug's activity has been confirmed against both focal and generalized epileptic seizures (epileptiform manifestations/photoparoxysmal response), indicating a broad spectrum of the pharmacological profile of levetiracetam.
Pharmacokinetics.
Levetiracetam is characterized by high solubility and permeability. The pharmacokinetics are linear, independent of time and characterized by low inter- and intra-subject variability. Clearance does not change after repeated administration of the drug. There was no evidence of an effect of gender, race or circadian rhythm on pharmacokinetics. The pharmacokinetic profile was similar in healthy volunteers and patients with epilepsy.
Due to complete and linear absorption, plasma levels can be predicted from the oral dose of levetiracetam, expressed in milligrams (mg) per kilogram (kg) of body weight. Therefore, monitoring of plasma levetiracetam levels is not necessary.
In adults and children, a significant correlation was observed between the drug concentration in saliva and blood plasma (the ratio of saliva/blood plasma concentrations ranged from 1 to 1.7 after taking the oral tablets and 4 hours after taking the oral solution).
Adults and adolescents
Absorption
Levetiracetam is rapidly absorbed after oral administration. Absolute oral bioavailability is close to 100%. Peak plasma concentrations (Cmax) are reached 1.3 hours after dosing. Steady state is reached after 2 days of twice daily dosing. Cmax is typically 31 μg/ml and 43 μg/ml after a single 1000 mg dose and a repeated 1000 mg dose twice daily, respectively. The extent of absorption is dose-independent and is not affected by food.
Distribution
There are no data on the distribution of the drug in human tissues. Neither levetiracetam nor its main metabolite is significantly bound to plasma proteins (< 10%). The volume of distribution of levetiracetam is 0.5 to 0.7 l/kg, which is approximately equal to the total body water volume.
Metabolism
Two minor metabolites were also identified. One was formed by hydroxylation of the pyrrolidone ring (1.6% of the dose), the other by opening of the pyrrolidone ring (0.9% of the dose).
Other unidentified components accounted for only 0.6% of the dose.
No interconversion of enantiomers of levetiracetam or its major metabolite was observed in vivo.
In vitro studies have shown that levetiracetam and its main metabolite do not inhibit the activity of the major human hepatic cytochrome P450 isoforms (CYP3A4, 2A6, 2C9, 2C19, 2D6, 2E1, 1A2), glucuronyltransferases (UGT1A1, UGT1A6) and epoxide hydroxylase. Levetiracetam also does not inhibit the glucuronidation of valproic acid in vitro.
In cultured human hepatocytes, levetiracetam had little or no effect on CYP1A1/2, SULT1E1 or UGT1A1 conjugation. At high concentrations (680 μg/ml), levetiracetam induced a slight induction of CYP2B6 and CYP3A4, but at concentrations similar to Cmax after repeated administration of 1500 mg twice daily, this effect was not biologically significant. In vitro and in vivo data on interactions with oral contraceptives, digoxin and warfarin indicate that no significant enzyme induction is expected under in vivo conditions. Therefore, interactions of levetiracetam with other substances are unlikely.
Breeding
The plasma elimination half-life in adults was 7 ± 1 hour and was independent of dose, route of administration, or repeated administration. The mean total clearance was 0.96 mL/min/kg.
The main amount of the drug, on average 95% of the dose, was excreted by the kidneys (approximately 93% of the dose was excreted within 48 hours). Only 0.3% of the dose was excreted in the feces.
The cumulative urinary excretion of levetiracetam and its major metabolite was 66% and 24% of the dose, respectively, in the first 48 hours. The renal clearance of levetiracetam and ucb L057 is 0.6 ml/min/kg and 4.2 ml/min/kg, respectively, indicating that levetiracetam is eliminated by glomerular filtration followed by tubular reabsorption and that the major metabolite is also eliminated by active tubular secretion in addition to glomerular filtration. Levetiracetam excretion correlates with creatinine clearance.
Elderly patients
In elderly patients, the elimination half-life is increased by approximately 40% (10-11 hours). This is due to impaired renal function in this population (see section "Method of administration and dosage").
Kidney dysfunction
The apparent total clearance of levetiracetam and its main metabolite correlates with creatinine clearance. Therefore, in patients with moderate to severe renal impairment, it is recommended to adjust the maintenance daily dose of levetiracetam according to creatinine clearance (see section 4.2).
In anuric patients with end-stage renal disease, the elimination half-life was approximately 25 and 3.1 hours, respectively, between and during dialysis. During a typical 4-hour dialysis session, 51% of levetiracetam was excreted.
Liver dysfunction
Levetiracetam clearance was not altered in patients with mild to moderate hepatic impairment. In most patients with severe hepatic impairment, levetiracetam clearance was reduced by more than 50% due to concomitant renal impairment (see section 4.2).
Pediatric population
Children aged 4–12 years
After a single dose (20 mg/kg) of levetiracetam to epileptic children (aged 6 to 12 years), the elimination half-life of levetiracetam was 6 hours. The apparent clearance, adjusted for body weight, was approximately 30% higher than in adult patients with epilepsy. After repeated oral administration (20–60 mg/kg/day) to epileptic children (aged 4 to 12 years), levetiracetam was rapidly absorbed. Cmax in plasma was reached 0.5–1 hour after dosing. Cmax and area under the pharmacokinetic concentration-time curve (AUC) increased linearly and were dose-dependent. The elimination half-life was approximately 5 hours, and the apparent total clearance was 1.1 ml/min/kg.
Indication
Monotherapy (first-choice drug) in the treatment of:
partial seizures with or without secondary generalization in adults and adolescents aged 16 years and older with newly diagnosed epilepsy.
As an additional therapy in the treatment of:
partial seizures with or without secondary generalization in adults and children aged 6 years and over with epilepsy;
myoclonic seizures in adults and adolescents aged 12 years and older with juvenile myoclonic epilepsy;
primary generalized tonic-clonic seizures in adults and adolescents aged 12 years and older with idiopathic generalized epilepsy.
Contraindication
Hypersensitivity to levetiracetam or other pyrrolidone derivatives, as well as to any of the excipients of the drug.
Interaction with other medicinal products and other types of interactions
Antiepileptic drugs
There are no data on clinically significant drug interactions in pediatric patients, as well as in adults receiving up to 60 mg/kg/day of levetiracetam.
A retrospective assessment of pharmacokinetic interactions in children and adolescents with epilepsy (aged 4 to 17 years) confirmed that adjunctive therapy with oral levetiracetam did not affect the steady-state serum concentrations of carbamazepine and valproate administered concomitantly. However, data suggest that the clearance of levetiracetam is 20% higher in children taking enzyme-inhibiting anticonvulsants. No dose adjustment is required.
Probenecid
Probenecid (500 mg 4 times daily), a drug that blocks renal tubular secretion, inhibits renal clearance of the major metabolite, but not levetiracetam itself. However, concentrations of this metabolite remain low.
Methotrexate
Concomitant use of levetiracetam and methotrexate has been reported to reduce the clearance of methotrexate, leading to increased/prolonged blood concentrations of methotrexate to potentially toxic levels. Methotrexate and levetiracetam blood levels should be closely monitored in patients receiving both drugs concurrently.
Oral contraceptives and pharmacokinetic interactions with other drugs
Levetiracetam at a daily dose of 1000 mg does not change the pharmacokinetics of oral contraceptives (ethinyl estradiol and levonorgestrel); endocrine parameters (luteinizing hormone and progesterone levels) did not change. Levetiracetam at a daily dose of 2000 mg does not change the pharmacokinetics of digoxin and warfarin; prothrombin time values remained unchanged. Digoxin, oral contraceptives and warfarin do not affect the pharmacokinetics of levetiracetam when used simultaneously.
Laxatives
In isolated cases, reduced efficacy of levetiracetam has been reported when the osmotic laxative macrogol was used concomitantly with oral levetiracetam. Therefore, oral macrogol should not be taken within one hour before or one hour after taking levetiracetam.
Food and alcohol
The extent of absorption of levetiracetam is independent of food intake, but the rate of absorption is slightly reduced when taken with food. There are no data on the interaction of levetiracetam with alcohol.
Application features
Kidney failure
Patients with renal impairment may require dose adjustment of levetiracetam. In patients with severe hepatic impairment, it is recommended that renal function be assessed before dose adjustment (see section 4.2).
Acute kidney injury
The use of levetiracetam has been very rarely associated with acute kidney injury, the time to onset of which ranged from a few days to several months.
Complete blood count
Rare cases of decreased blood cell counts (neutropenia, agranulocytosis, leukopenia, thrombocytopenia and pancytopenia) have been reported in association with levetiracetam, usually at the start of treatment. Complete blood counts are recommended in patients who present with significant weakness, fever, recurrent infections or coagulation disorders (see section 4.8).
Suicide
Cases of suicide, suicide attempts, suicidal thoughts and behaviour have been reported in patients treated with antiepileptic drugs (including levetiracetam). A meta-analysis of randomised placebo-controlled trials of antiepileptic drugs has shown a small increased risk of suicidal thoughts and behaviour. The mechanism of this risk is not known. In view of this risk, patients should be monitored for signs of depression, suicidal thoughts and behaviour and their treatment should be adjusted if necessary. Patients (or their carers) should be advised to report any symptoms of depression, suicidal thoughts and behaviour to their doctor.
Unusual or aggressive behavior
Levetiracetam may cause psychotic symptoms and behavioral disturbances, including irritability and aggression. Patients taking levetiracetam should be monitored for the development of psychiatric symptoms indicative of significant changes in mood and/or personality. If such behaviour occurs, it is recommended to adjust the treatment or gradually discontinue it. If treatment discontinuation is necessary, see the information in the section “Method of administration and dosage”.
Worsening of attacks
As with other antiepileptic drugs, levetiracetam may occasionally increase the frequency or severity of seizures. This paradoxical effect has been reported most frequently within the first month of levetiracetam use or with dose increases. This effect was reversible upon discontinuation of the drug or with dose reduction. Patients should be advised to seek immediate medical advice if their epilepsy worsens. For example, lack of efficacy or worsening of seizures has been reported in patients with epilepsy associated with mutations in the voltage-gated sodium channel alpha subunit 8 (SCN8A).
During post-marketing surveillance, rare cases of QT prolongation on ECG have been reported. Levetiracetam should be used with caution in patients with QT prolongation, in patients taking concomitant medications that affect the QT interval, and in patients with underlying cardiac disease or electrolyte imbalance.
Children.
The drug in tablet form is not suitable for use in infants and children under 6 years of age.
Available data in children do not indicate any effects on development and puberty. However, the long-term effects on learning ability, intelligence, development, endocrine function, puberty and reproductive function in children remain unknown.
Use during pregnancy or breastfeeding
Women of reproductive age
Special advice should be given to women of childbearing potential. Levetiracetam treatment should be reconsidered if a woman is planning to become pregnant. As with all antiepileptic drugs, abrupt withdrawal of levetiracetam should be avoided as it may lead to seizures, which may have serious consequences for the woman and the unborn child. Monotherapy should be preferred whenever possible, as treatment with multiple antiepileptic drugs may be associated with a higher risk of congenital malformations than monotherapy, depending on the combination of drugs.
Pregnancy
A large amount of post-marketing data from pregnant women exposed to levetiracetam (more than 1800 women, including 1500 women exposed during the first trimester) do not indicate an increased risk of major birth defects. There are only limited data on the development of the nervous system in children exposed to levetiracetam monotherapy in utero. However, available epidemiological studies (approximately 100 children) do not indicate an increased risk of disorders or delays in the development of the nervous system. Levetiracetam can be used during pregnancy if, after careful assessment, it is considered clinically necessary. In such cases, the lowest effective dose is recommended.
Physiological changes during pregnancy may alter levetiracetam concentrations. Decreases in plasma levetiracetam concentrations have been observed during pregnancy. This decrease is most pronounced in the third trimester (up to 60% of pre-pregnancy baseline concentrations). Appropriate clinical monitoring of pregnant women receiving levetiracetam should be ensured.
Breastfeeding period
Levetiracetam is excreted in human milk. Breastfeeding is therefore not recommended. However, if levetiracetam must be used during breast-feeding, the benefits and risks of treatment should be weighed against the importance of breast-feeding.
Impact on reproductive function
No effects on reproductive function were observed in animals. The potential risk for humans is unknown as no clinical data are available.
Ability to influence reaction speed when driving vehicles or other mechanisms
Levetiracetam has minor or moderate influence on the ability to drive and use machines. Due to possible individual sensitivity, some patients may experience drowsiness, dizziness and other symptoms associated with the effects on the central nervous system, especially at the beginning of treatment or during dose increases. Therefore, such patients should be careful when engaging in activities that require increased concentration, such as driving or operating other machines. Patients are advised to refrain from driving or operating other machines until it is established that their ability to perform such activities is not impaired.
Method of administration and doses
The tablets should be taken orally with sufficient liquid, with or without food. When taken orally, levetiracetam may have a bitter taste.
Divide the daily dose into 2 equal doses.
Partial seizures
The recommended dose for monotherapy (patients aged 16 years and over) and adjunctive therapy is the same and is listed below.
All indications
Adults (≥ 18 years) and adolescents (12 to 17 years) weighing 50 kg or more
The initial therapeutic dose is 500 mg twice daily. This is the initial dose administered on the first day of treatment. However, a lower initial dose of 250 mg twice daily may be used by the physician based on an assessment of the reduction in seizure frequency compared to potential adverse reactions. This dose may be increased to 500 mg twice daily after 2 weeks.
Depending on the clinical picture and tolerability of the drug, the daily dose can be increased to a maximum of 1500 mg 2 times a day. The dose can be changed to 250 mg or 500 mg 2 times a day every 2-4 weeks.
Children aged 6 years and above and adolescents (aged 12 to 17 years) weighing less than 50 kg
The physician should prescribe the most appropriate dosage form, dosage and release form based on body weight, age and dose. For information on dose adjustment based on body weight, see the Children section.
If it is necessary to discontinue the drug, it is recommended to do so gradually (for example, for adults and adolescents weighing 50 kg or more, reduce the dose by 500 mg 2 times a day every 2-4 weeks; for children and adolescents weighing less than 50 kg, reduce the single dose by no more than 10 mg/kg 2 times a day every 2 weeks).
Special patient groups
Elderly patients (aged 65 years and over)
Dose adjustment is recommended for elderly patients with impaired renal function (see section "Renal failure").
Kidney failure
The daily dose should be individually adjusted according to the state of renal function.
To adjust the dose for adults, use the table below.
To adjust the dose according to the table, it is necessary to determine the level of creatinine clearance (CC) in ml/min.
The creatinine clearance for adults and adolescents weighing more than 50 kg can be calculated based on serum creatinine concentration using the formula:
[140 ─ age (years)] × body weight (kg)
CC (ml/min) = --------------------------------------------------------------× 0.85 (for women).
72 × Serum CC (mg/dL)
Then adjust the CK according to body surface area (BSA) as shown below:
CC (ml/min)
CC (ml/min/1.7Zm2) = --------------------------- × 1.73.
Patient's PPT (m2)
Table 1
Dosage regimen in renal insufficiency for adults and adolescents with renal insufficiency weighing more than 50 kg
| Severity of renal failure | Creatinine clearance (ml/min/1.73 m2) | Dosage regimen |
| Normal kidney function | > 80 | 500 - 1500 mg 2 times a day |
| Easy degree | 50-79 | 500 - 1000 mg 2 times a day |
| Intermediate level | 30-49 | 250 - 750 mg 2 times a day |
| Severe degree | < 30 | 250 - 500 mg 2 times a day |
| End-stage (patients on dialysis(1)) | - | 500 - 1000 mg once daily(2) |
(1) A loading dose of 750 mg is recommended on the first day of levetiracetam treatment.
(2) After dialysis, an additional dose of 250-500 mg is recommended.
For children with renal impairment, the dose of levetiracetam should be adjusted according to renal function, as the clearance of levetiracetam is related to renal function. This recommendation is based on a study in adult patients with renal impairment.
For adolescents, children, and infants, the creatinine clearance in mL/min/1.73 m2 can be calculated from the serum creatinine concentration (mg/dL) using the following formula (Schwarz formula):
Height (cm) × ks
CC (ml/min/1.73 m2) = --------------------------------- .
Serum CK (mg/dL)
In children under 13 years of age and adolescent girls, ks = 0.55, in adolescent boys, ks = 0.7.
Table 2
Dose adjustment recommendations for children (aged 6 years and above) and adolescents with renal impairment weighing less than 50 kg
| Severity of renal failure | Creatinine clearance (ml/min/1.73 m2) | Children aged 6 years and above and adolescents weighing less than 50 kg(1) |
| Normal kidney function | > 80 | 10-30 mg/kg (0.10-0.30 ml/kg) 2 times a day |
| Easy degree | 50-79 | 10-20 mg/kg (0.10-0.20 ml/kg) 2 times a day |
| Intermediate level | 30-49 | 5-15 mg/kg (0.05-0.15 ml/kg) 2 times a day |
| Severe degree | < 30 | 5-10 mg/kg (0.05-0.10 ml/kg) 2 times a day |
| End-stage (patients on dialysis) | - | 10-20 mg/kg (0.10-0.20 ml/kg) once daily (2)(3) |
(1) For doses up to 250 mg, for doses not multiples of 250 mg, when the recommended dosage cannot be achieved by taking multiple tablets, and for patients who cannot swallow tablets, levetiracetam oral solution (100 mg/ml) should be used.
(2) A loading dose of 15 mg/kg (0.15 ml/kg) of levetiracetam is recommended on the first day of treatment.
(3) After dialysis, an additional dose of 5-10 mg/kg (0.05-0.10 ml/kg) is recommended.
Liver failure
No dose adjustment is required in patients with mild to moderate hepatic impairment. In patients with severe hepatic impairment, creatinine clearance may not fully reflect the severity of renal impairment. Therefore, if creatinine clearance is < 60 ml/min/1.73 m2, a 50% reduction in the maintenance daily dose is recommended.
Children
The physician should prescribe the most appropriate dosage form, dosage and release form of levetiracetam depending on age, body weight and dose.
Levetiracetam in tablet form is not recommended for use in children under 6 years of age. Levotiracetam in oral solution form is preferable for this group of patients.
In addition, the available tablet dosages are not recommended for initial treatment of children weighing less than 25 kg, for patients who cannot swallow tablets, or for doses up to 250 mg. Age restrictions due to the form of the disease are provided in the "Indications" section. In all of the above cases, treatment should be initiated with levetiracetam in the form of an oral solution.
Monotherapy
The safety and efficacy of levetiracetam as monotherapy in children and adolescents under 16 years of age have not been established.
Adolescents (aged 16–17 years) weighing 50 kg or more with partial seizures with or without secondary generalization, who have been diagnosed with epilepsy for the first time
See above section “Adults (≥ 18 years) and adolescents (12–17 years) weighing 50 kg or more”.
Add-on therapy for children aged 6 years and older and adolescents (aged 12 to 17 years) weighing less than 50 kg
For infants and children under 6 years of age, it is preferable to use levetiracetam in the form of an oral solution.
In children aged 6 years and older, levetiracetam oral solution should be used for doses up to 250 mg, for doses not multiples of 250 mg when the recommended dosage cannot be obtained by taking multiple tablets, and for patients who cannot swallow tablets.
For all indications, the lowest effective dose should be used. The starting dose for a child or adolescent weighing 25 kg should be 250 mg twice daily, the maximum dose is 750 mg twice daily.
Children weighing more than 50 kg are prescribed the dosage for all indications according to the scheme given for adults.
See above section “Adults (≥ 18 years) and adolescents (12–17 years) weighing 50 kg or more” for all indications.
Adjunctive therapy for infants aged 1 to 6 months
Infants are given the drug in the form of an oral solution.
Children.
Levetiracetam tablet form is not recommended for use in children under 6 years of age. Levetiracetam oral solution should be used in infants from 1 month of age and children up to 6 years of age.
Overdose
Symptoms
In case of overdose with levetiracetam, drowsiness, agitation, aggression, respiratory depression, depression of consciousness, coma were observed.
Treatment
In case of acute overdose, gastric lavage or induce vomiting is necessary. There is no specific antidote. If necessary, symptomatic treatment should be carried out, including hemodialysis (up to 60% of levetiracetam and 74% of the primary metabolite are removed).
Side effects
The most commonly reported adverse reactions were nasopharyngitis, somnolence, headache, fatigue and dizziness. The adverse reaction profile presented is based on a pooled analysis of placebo-controlled clinical trials. These data are supplemented by the use of levetiracetam in relevant open-label extension studies and post-marketing experience. The safety profile of levetiracetam is generally similar across age groups (adults and children) when used in the various established indications for epilepsy.
Adverse reactions reported in clinical trials (in adults, adolescents, children and infants from 1 month of age) and during the post-marketing period are listed in Table 3 by system organ class and frequency. The frequency is defined as follows: very common (≥ 1/10), common (≥ 1/100, < 1/10), uncommon (≥ 1/1,000, < 1/100), rare (≥ 1/10,000, < 1/1,000) and very rare (< 1/10,000).
Table 3
| MedDRA system organ classes | Frequency groups |
| Very often | Often | Infrequently | Rarely | Very rarely |
| Infections and infestations | Nasopharyngitis | | | Infection | |
From the side blood and lymphatic system | | | Thrombocytopenia, leukopenia | Pancytopenia, neutropenia, agranulocytosis | |
From the side immune system | | | | Drug reaction with eosinophilia and systemic symptoms (DRESS), hypersensitivity (including angioedema and anaphylaxis) | |
| Nutritional and metabolic disorders | | Anorexia | Weight loss, weight gain | Hyponatremia | |
| Mental disorders | | Depression, hostility/aggression, anxiety, insomnia, nervousness/irritability | Suicide attempt, suicidal ideation, psychotic disorder, abnormal behavior, hallucinations, anger, confusion, panic attacks, affective lability/mood swings, agitation | Suicide, personality disorders, thought disorders, delirium | Obsessive-compulsive disorders |
| From the nervous system | Drowsiness, headache | Convulsions, balance disorders, dizziness, lethargy, tremor | Amnesia, memory impairment, coordination disorder/ataxia, paraesthesia, disturbance in attention | Choreoathetosis, dyskinesia, hyperkinesia, gait disturbance, encephalopathy, increased seizures, neuroleptic malignant syndrome* | |
| From the organs of vision | | | Diplopia, blurred vision | | |
| Hearing and balance disorders | | Vertigo | | | |
| From the heart | | | | QT prolongation on ECG | |
| Respiratory, thoracic and mediastinal disorders | | Cough | | | |
| From the digestive system | | Abdominal pain, diarrhea, dyspepsia, vomiting, nausea | | Pancreatitis | |
| Hepatobiliary disorders | | | Abnormal liver test results | Liver failure, hepatitis | |
| From the kidneys and urinary system | | | | Acute kidney injury | |
Skin and subcutaneous tissue disorders | | Rash | Alopecia, eczema, itching | Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme | | | Musculoskeletal and connective tissue disorders | | | Muscle weakness, myalgia | Rhabdomyolysis and elevated blood creatine phosphokinase levels* | |
| General violations | | Asthenia/fatigue | | | |
| Injuries, poisonings and procedural complications | | | Injuries | | |
*Prevalence is significantly higher in Japanese compared to non-Japanese patients.
**During post-marketing surveillance, very rare cases of obsessive-compulsive disorder (OCD) have been reported in patients with a history of OCD or psychiatric disorders.
Description of selected adverse reactions
The risk of anorexia increases with concomitant use of levetiracetam with topiramate. In cases of alopecia, hair regrowth has been observed in some cases after discontinuation of levetiracetam.
Bone marrow suppression has been observed in some cases of pancytopenia.
Cases of encephalopathy were usually observed early in treatment (from a few days to several months) and were reversible after discontinuation of treatment.
Children
The adverse reaction profile of levetiracetam is generally similar across age groups and across all approved epilepsy indications. The safety profile of levetiracetam in children in placebo-controlled clinical trials was consistent with the safety profile of levetiracetam in adults, except for behavioural and psychiatric adverse reactions, which were more frequent in children than in adults. In children and adolescents aged 4 to 16 years, vomiting (very common, 11.2%), agitation (common, 3.4%), mood swings (common, 2.1%), affective lability (common, 1.7%), aggression (common, 8.2%), abnormal behaviour (common, 5.6%) and lethargy (common, 3.9%) were observed at a higher frequency than in other age groups or in the overall safety profile. In infants and children aged 1 month to 4 years, irritability (very common, 11.7%) and incoordination (common, 3.3%) were observed at a higher frequency than in other age groups or in the overall safety profile.
An evaluation of the effects of levetiracetam on cognitive and neuropsychological measures in children aged 4 to 16 years with partial onset seizures showed that levetiracetam was non-different (non-inferior) to placebo in terms of change from baseline in attention and memory on the Leiter-R scale, a population-based summary measure of memory testing, as per protocol. Results related to behavioral and emotional functioning indicated an increase in aggressive behavior in levetiracetam-treated patients, as measured in a standardized and systematic manner using validated measures (Achenbach Child Behavior Checklist). However, in patients treated with levetiracetam in the long-term open-label follow-up study, there was no mean deterioration in behavioral and emotional functioning, and in particular, aggressive behavior scores were not worse than baseline.
Reporting of suspected adverse reactions
Reporting adverse reactions after the registration of a medicinal product is important. This allows monitoring of the benefit/risk ratio of the medicinal product. Medical and pharmaceutical professionals, as well as
