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Levetiracetam ER vs Levetiracetam (regular / immediate release)

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    November 14, 2022 3:15 PM EST

    Question submitted during Session III of The Canine Epilepsy Summit:

    Regarding the emergency treatment of seizures:

    "We are on the ER Levetiracetam. Is the ER as effective in combination with rectal diazepam as the “regular” Levetiracetam?"

    - Answer provided by a Session III Panelist:

    In an emergency situation, we typically recommend using the regular, immediate release formulation, even if dogs are being administered extended release levetiracetam as maintenance therapy.

    Regarding the half-life of these drugs:

    "Is there a difference in consistent half-life between standard Keppra (every 8 hrs) and Keppra XR (every 12 hrs)? When my dog has breakthrough seizures, they are almost always within about 45 min of when she will get a dosage (seizes at 5:30-6:00am when she gets her meds at 6:30am), so I'm wondering if it's wearing off faster overnight?"

    - Answer provided by Dr. Karen Muñana:

    The half life of the extended release formulation of levetiracetam is longer than the immediate release formulation, which is why it only needs to be given every 12 hours rather than every 8 hours. I have had some patients who have had better seizure control with the immediate release formulation compared to the extended release. In general, dogs that tend to have seizures immediately before the next dose of medication may have blood levels of their medication that is dipping below the target range, and a medicaton adjustment may be necessary. I recommend that you speak to your veterinarian about this.

    Many dog owners choose the extended release formulation of levetiracetam because it is much easier to administer, but some dogs respond better to the immediate release formulation compared to the extended release formulation.