레베티라세탐
Levetiracetam
S-Etriacetam / Pyrrolidone-derivative
다른 이름: Keppra XR · Desitrend · S-Etriacetam · UCB-22059 · UCBL059 · S-Etiracetam
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| As an add-on treatment for epilepsy in dogs refractory to phenobarbital and bromides | 20 mg/kg PO every 8 hours | PO | q8h | — | 🌎 NA |
| As an add-on treatment for epilepsy in dogs refractory to phenobarbital and/or bromides | 7.1-23.8 mg/kg PO every 8 hours | PO | q8h | — | 🌎 NA |
| Seizure management | 10-20 mg/kg PO q8h | PO | q8h | — | 🌎 NA |
| Seizure management | Initially, 20 mg/kg PO q8h. May increase dose in 20 mg/kg increments until efficacy achieved, side effects become apparent, or the drug becomes cost prohibitive. | PO | q8h | — | 🌎 NA |
| Seizure management | 20 mg/kg PO q8h; may also be given as an IV bolus (20 mg/kg). | PO/IV | q8h | — | 🌎 NA |
| Single-dose pharmacokinetic study | 60 mg/kg IV bolus dose | IV | Once | — | 🌎 NA |
| For status epilepticus | Initially, lorazepam at 0.2 mg/kg IV once, followed by a bolus IV loading dose of levetiracetam at 60 mg/kg. | IV | Once | — | 🌎 NA |
- Single-dose pharmacokinetic study: Well tolerated and achieves plasma drug concentrations within or above the therapeutic range reported for humans for at least 8 hours.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| As an add-on to phenobarbital treatment for epilepsy | Initially, 20 mg/kg PO three times daily; slowly increase to effect | PO | TID | — | 🌎 NA |
| As an adjunct to phenobarbital in suspected idiopathic epilepsy | Initially, 20 mg/kg PO three times daily. Monitor as below. If ineffective, increase dose in 20 mg/kg increments. | PO | TID | — | 🌎 NA |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
레베티라세탐(Levetiracetam)은 수의학에서 주로 보조 요법으로 사용되는 구조적으로 독특한 새로운 항경련제입니다.
- 개: 페노바르비탈이나 브롬화칼륨이 금기이거나 내성이 없는 경우, 또는 난치성 간질의 3차 약물로 사용됩니다. 개에서는 장기간 사용 시 효과가 감소하는 '허니문 효과'가 나타날 수 있으므로 주의가 필요합니다.
- 고양이: 일반적으로 페노바르비탈로 효과가 불충분할 때 2차 추가 약물로 사용되거나, 페노바르비탈에 내성이 없는 경우 단독 요법으로 사용됩니다.
임상 요점: 간 대사가 거의 없고 시토크롬 P450 효소계에 의존하지 않으므로 간 기능이 손상된 환자에게 매우 적합합니다. 그러나 반감기가 짧아 자주(하루 3번) 투약해야 하므로 보호자에게 부담이 될 수 있습니다.
작용 기전
The exact mechanism of levetiracetam's antiseizure activity is not fully elucidated, but it is distinct from traditional anticonvulsants (which typically affect GABA or ion channels).
- Binds specifically to Synaptic Vesicle Protein 2A (SV2A) in the central nervous system.
- Binding to SV2A → modulates neurotransmitter release into the synaptic cleft → selectively prevents hypersynchronization of epileptiform burst-firing and propagation of seizure activity.
- It does not affect normal neuronal excitability.
안전성·주의사항
금기사항
- Hypersensitivity to levetiracetam or any of its components
- Severe renal disease
부작용
- Sedation (most common in dogs)
- Lethargy (most common in cats)
- Decreased appetite (most common in cats)
- Behavior changes
- Gastrointestinal effects
- Sedation (dogs)
- Ataxia (dogs)
- Reduced appetite (cats)
- Hypersalivation (cats)
- Lethargy (cats)
주의
Renal Impairment: Clearance is primarily renal (glomerular filtration and active tubular secretion). Dosage amounts or intervals must be adjusted in patients with decreased creatinine clearance.
- Pregnancy/Nursing: FDA Category C. High doses in animal models showed embryofetal mortality and minor skeletal abnormalities. Excreted in maternal milk; use with caution in nursing patients.
- Withdrawal: Abrupt discontinuation may precipitate withdrawal seizures; taper slowly if discontinuing.
약물 상호작용
May increase the risk for seizures (reported in humans; veterinary significance unclear).
Significantly increases levetiracetam clearance and reduces its half-life in dogs (from 3.43 hrs to 1.73 hrs); dosage adjustments may be required.
모니터링
- Therapeutic drug monitoring (target range 5-45 mcg/mL) approximately one week after starting, then every 6-12 months (primarily to adjust dosage)
- Seizure activity log (frequency, duration, severity)
- Routine CBC and basic metabolic panel every 6 months
- Adverse effects (sedation, lethargy, appetite changes)
- Seizure frequency and severity
- Renal function (BUN, Creatinine, SDMA) especially in older patients
- Therapeutic drug monitoring is rarely required but can be performed
약동학
반감기
흡수
Well absorbed after oral dosing; peak levels occur in about 2 hours in dogs and cats. In humans, food delays the rate but not the extent of absorption.
분포
Volume of distribution is about 0.9 L/kg in dogs. Less than 10% bound to plasma proteins in humans.
대사
Not extensively metabolized. The acetamide group is enzymatically hydrolyzed to an inactive carboxylic acid metabolite. Hepatic CYP P450 isoenzymes are not involved.
배설
Primarily excreted unchanged via renal mechanisms (glomerular filtration and active tubular secretion). Clearance is significantly reduced in renal impairment.
과다투여
Levetiracetam is a relatively safe agent.
- Dogs: Doses of 1200 mg/kg/day (~20x therapeutic dose) caused only salivation and vomiting.
- Humans: Doses of 6000 mg/kg caused drowsiness. Other reported effects include depressed consciousness, agitation, aggression, and respiratory depression.
- Treatment: Basically supportive. The drug can be removed with hemodialysis. Contact an animal poison control center for significant overdoses.
제품
제형
- Oral Tablets (film-coated, scored)
- Extended-Release Oral Tablets
- Concentrate for Injection
- Oral tablets: 250 mg, 500 mg, 750 mg, 1 g
- Oral solution: 100 mg/ml (300 ml bottle)
- Coated granules: 250 mg/sachet
- Injectable solution: 100 mg/ml (5 ml vial)
- Infusion solution: formulated with sodium chloride at 500 mg/100 ml, 1000 mg/100 ml, 1500 mg/100 ml
인용의약품
- Levetiracetam Oral Tablets (film-coated, scored): 250 mg, 500 mg, 750 mg & 1000 mg (Keppra, generic)
- Levetiracetam Extended-Release Oral Tablets: 500 mg & 750 mg (Keppra XR)
- Levetiracetam Oral Solution: 100 mg/mL (Keppra, generic)
- Levetiracetam Concentrate for Injection: 100 mg/mL in 5 mL single-use vials (Keppra)
- Desitrend
- Keppra (250 mg, 500 mg, 750 mg, 1 g tablets; 100 mg/ml oral solution; 100 mg/ml IV solution)
규제 현황
POM (Prescription Only Medicine)
POM (Prescription Only Medicine)
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Tablets or oral solution should be stored at 25°C (77°F); excursions permitted to 15-30°C (59-86°F).
보호자 정보
- 엄격한 투약 일정: 이 약은 처방된 대로 정확히, 보통 8시간마다(하루 3번) 투약해야 합니다. 투약을 거르면 발작이 일어날 수 있습니다.
- 부작용: 초기에는 반려동물이 졸려 하거나, 무기력하거나, 식욕이 떨어질 수 있습니다. 이러한 부작용은 대개 약에 적응하면서 호전됩니다.
- 발작 일지: 수의사가 용량을 조절하는 데 도움이 되도록 발작이 일어난 날짜, 시간, 지속 시간, 심각도를 자세히 기록해 주세요.
임의로 중단하지 마세요: 갑자기 약을 끊으면 심각하고 생명을 위협하는 발작을 유발할 수 있습니다. 용량을 변경하기 전에 반드시 수의사와 상담하세요.
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