VetSheet

左乙拉西坦

Levetiracetam

S-Etriacetam / Pyrrolidone-derivative

抗癲癇藥POIVRectal狗貓

別名: Keppra XR · Desitrend · S-Etriacetam · UCB-22059 · UCBL059 · S-Etiracetam

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

20 mg/kg PO every 8 hoursPO· q8h
— 🐕

劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。

各物種劑量

🌎 NA — North America🌍 EU — Europe

狗

適應症劑量途徑頻次療程地區
As an add-on treatment for epilepsy in dogs refractory to phenobarbital and bromides20 mg/kg PO every 8 hoursPOq8h—🌎 NA
As an add-on treatment for epilepsy in dogs refractory to phenobarbital and/or bromides7.1-23.8 mg/kg PO every 8 hoursPOq8h—🌎 NA
Seizure management10-20 mg/kg PO q8hPOq8h—🌎 NA
Seizure managementInitially, 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.POq8h—🌎 NA
Seizure management20 mg/kg PO q8h; may also be given as an IV bolus (20 mg/kg).PO/IVq8h—🌎 NA
Single-dose pharmacokinetic study60 mg/kg IV bolus doseIVOnce—🌎 NA
For status epilepticusInitially, lorazepam at 0.2 mg/kg IV once, followed by a bolus IV loading dose of levetiracetam at 60 mg/kg.IVOnce—🌎 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.

貓

適應症劑量途徑頻次療程地區
As an add-on to phenobarbital treatment for epilepsyInitially, 20 mg/kg PO three times daily; slowly increase to effectPOTID—🌎 NA
As an adjunct to phenobarbital in suspected idiopathic epilepsyInitially, 20 mg/kg PO three times daily. Monitor as below. If ineffective, increase dose in 20 mg/kg increments.POTID—🌎 NA

劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。

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概覽

​左乙拉西坦 (Levetiracetam)​ 是一種新型且結構獨特的抗癲癇藥物，在獸醫學中主要作為輔助治療。

  • ​犬：​ 作為難治性癲癇的第三線藥物，或在苯巴比妥/溴化鉀有禁忌或耐受不良時使用。需注意犬隻長期使用可能出現「蜜月期效應」（療效隨時間下降）。
  • ​貓：​ 通常在苯巴比妥療效不足時作為二線附加藥物，或在無法耐受苯巴比妥時作為單一療法。

​臨床要點：​ 該藥物極少經肝臟代謝，且不依賴細胞色素 P450 系統，因此非常適合肝功能受損的病患。然而，其半衰期短，需要頻繁給藥（一天三次），對飼主而言可能是一大挑戰。

作用機轉

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.

安全性與警告

禁忌症

  • Hypersensitivity to levetiracetam or any of its components
  • Severe renal disease

不良反應

  • 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)

注意事項

​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.

藥物交互作用

NSAIDs (naproxen, ketorolac)

May increase the risk for seizures (reported in humans; veterinary significance unclear).

PhenobarbitalModerate

Significantly increases levetiracetam clearance and reduces its half-life in dogs (from 3.43 hrs to 1.73 hrs); dosage adjustments may be required.

監測

  • 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

藥物動力學

半衰期

貓~3 hours (wide inter-patient variation)狗2-5 hours

吸收

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.

分佈

Volume of distribution is about 0.9 L/kg in dogs. Less than 10% bound to plasma proteins in humans.

代謝

Not extensively metabolized. The acetamide group is enzymatically hydrolyzed to an inactive carboxylic acid metabolite. Hepatic CYP P450 isoenzymes are not involved.

排除

Primarily excreted unchanged via renal mechanisms (glomerular filtration and active tubular secretion). Clearance is significantly reduced in renal impairment.

過量

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.

可用產品

劑型

  • 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

人用標示

  • 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)

各地核准狀態

European Union✓ 已核准處方藥EMA
🐕 Dogs🐈 Cats

POM (Prescription Only Medicine)

United Kingdom✓ 已核准處方藥VMD
🐕 Dogs🐈 Cats

POM (Prescription Only Medicine)

暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

Tablets or oral solution should be stored at 25°C (77°F); excursions permitted to 15-30°C (59-86°F).

飼主須知

  • ​嚴格的給藥時間​：此藥物必須完全依照醫囑給藥，通常為​每8小時（一天三次）​。漏藥可能導致癲癇突破性發作。
  • ​副作用​：初期您的寵物可能會出現嗜睡、精神不佳或食慾下降。這些副作用通常會隨著寵物適應藥物而改善。
  • ​癲癇日誌​：請詳細記錄任何癲癇發作的情況（日期、時間、持續時間和嚴重程度），以協助獸醫師調整劑量。

​切勿自行停藥​：突然停止使用此藥物可能引發嚴重且危及生命的癲癇發作。在更改劑量前，請務必諮詢您的獸醫師。

VetSheet 藥物參考供合格獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠商最新仿單。