ld be avoided in these patient populations, with the exception of treating seizure and mood disorders, since anticonvulsants can produce ataxia, impaired psychomotor function, syncope, and additional falls. The Beers expert panel also recommends reducing the dose of levetiracetam in geriatric patients with a creatinine clearance of 80 mL/min or less due to the potential for adverse CNS effects. The federal Omnibus Budget Reconciliation Act (OBRA) provides guidance for the use of anticonvulsants in residents of long-term care facilities. The need for indefinite continuation should be based on confirmation of the condition and its potential cause(s). When the anticonvulsant is being used to manage behavior, stabilize mood, or treat a psychiatric disorder, the facility should attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines.
Children, infants, neonates
Monitor blood pressure in neonates, infants, and children < 4 years of age receiving levetiracetam. During clinical trials, children 1 month to < 4 years who were treated with levetiracetam had a significantly higher risk of increased diastolic pressure compared to those treated with placebo (17% vs. 2%, respectively). There was no overall difference in the mean diastolic blood pressure between treatment groups, and an increased risk was not observed in studies of older children or adults.
ADVERSE REACTIONS
Severe
proteinuria / Delayed / 4.0-4.0
toxic epidermal necrolysis / Delayed / 0-1.0
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) / Delayed / 0-1.0
Stevens-Johnson syndrome / Delayed / 0-1.0
acute generalized exanthematous pustulosis (AGEP) / Delayed / 0-1.0
suicidal ideation / Delayed / 0.5-0.5
erythema multiforme / Delayed / Incidence not known
pancytopenia / Delayed / Incidence not known
agranulocytosis / Delayed / Incidence not known
hepatic failure / Delayed / Incidence not known
pancreatitis / Delayed / Incidence not known
anaphylactic shock / Rapid / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
seizures / Delayed / Incidence not known
Moderate
hallucinations / Early / 1.0-17.0
psychosis / Early / 1.0-17.0
hypertension / Early / 0-17.0
eosinophilia / Delayed / 8.6-8.6
depression / Delayed / 3.0-5.0
constipation / Delayed / 3.0-3.0
conjunctivitis / Delayed / 3.0-3.0
dehydration / Delayed / 2.0-2.0
confusion / Early / 2.0-2.0
hostility / Early / 2.0-2.0
amnesia / Delayed / 2.0-2.0
pneumonitis / Delayed / 0-1.0
myasthenia / Delayed / Incidence not known
hyponatremia / Delayed / Incidence not known
anemia / Delayed / Incidence not known
thrombocytopenia / Delayed / Incidence not known
leukopenia / Delayed / Incidence not known
neutropenia / Delayed / Incidence not known
elevated hepatic enzymes / Delayed / Incidence not known
hepatitis / Delayed / Incidence not known
Mild
asthenia / Delayed / 9.0-15.0
vomiting / Early / 15.0-15.0
rhinitis / Early / 4.0-13.0
infection / Delayed / 13.0-13.0
anorexia / Delayed / 3.0-13.0
irritability / Delayed / 6.0-11.7
cough / Delayed / 2.0-11.0
pharyngitis / Delayed / 6.0-10.0
nasal congestion / Early / 9.0-9.0
abdominal pain / Early / 0-9.0
musculoskeletal pain / Early / 2.0-8.0
influenza / Delayed / 3.0-8.0
diarrhea / Early / 8.0-8.0
lethargy / Early / 6.0-6.0
nausea / Early / 5.0- |
