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نشرة الممارس الصحي نشرة معلومات المريض بالعربية نشرة معلومات المريض بالانجليزية صور الدواء بيانات الدواء
  SFDA PIL (Patient Information Leaflet (PIL) are under review by Saudi Food and Drug Authority)

Vetam® contains the active ingredient levetiracetam. It belongs to antiepileptic medicines, which are used to treat fits (seizures) in epilepsy.

On its own, Vetam® is used to treat:

Partial onset seizure with or without secondary generalisation (the epilepsy form in which the fits initially affect only one side of the brain, but could thereafter extend to larger areas on both sides of the brain) - in adults and adolescents from 16 years of age with newly diagnosed epilepsy.

As an add-on to other antiepileptic medicines, Vetam® is used to treat:

Partial onset seizures with or without generalisation in adults, adolescents, children and infants from one month of age with epilepsy.

Myoclonic seizures (short, shock-like jerks of a muscle or group of muscles) in adults and adolescents from 12 years of age with juvenile myoclonic epilepsy.

Primary generalised tonic-clonic seizures (major fits, including loss of consciousness) in adults and adolescents from 12 years of age with idiopathic generalised epilepsy (the type of epilepsy that is thought to have a genetic cause).


Don’t take Vetam®:

If you are allergic (hypersensitive) to levetiracetam, other pyrrolidone derivatives, or any other ingredients of Vetam®.

If you think any of these apply to you, don’t take Vetam® until you have checked with your doctor.

Take special care with Vetam®

Before you take Vetam® your doctor needs to know:

If you have kidney problems or severe liver disease, your doctor may need to adjust your dose of Vetam®.

If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby.

If you are taking any other medicines.

If you are over 65.

Check with your doctor if you think any of these may apply to you. Your doctor will decide whether Vetam® is suitable for you.

Children and adolescents

Vetam® film-coated tablets are not recommended for children under 6 years.

Levetiracetam oral solution is the preferred formulation for use in infants and children under the age of 6 years.

Vetam® is not indicated in children and adolescents below 16 years on its own (as monotherapy).

While you are taking Vetam®

If you notice any slowdown in the growth or unexpected puberty development of your child, contact your doctor.

A small number of people being treated with anti-epileptics such as levetiracetam have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor.

Conditions you need to look out for

Vetam® can make some existing conditions worse, or cause serious side effects such as severe allergic reactions, serious skin reactions, Drug reaction with eosinophilia and Systemic symptoms (DRESS), sudden decrease of kidney function, encephalopathy (degenerative disease of the brain), depression or suicidal thoughts. You must look out for certain symptoms while you are taking Vetam®, to reduce the risk of any problems.

Other medicines and Vetam®

Tell your doctor or pharmacist if you’re taking any other medicines, if you’ve taken any recently, or if you start taking new ones. This includes medicines bought without a prescription.

Don’t take macrogol (a drug used as laxative) for one hour before and one hour after taking Vetam® as this may results in a loss of its effect.

You will be closely monitored if you are taking Vetam® with:

Methotrexate (used to treat certain types of cancer).

Some other medicines may affect how Vetam® works, or make it more likely that you’ll have side effects. Vetam® can also affect how some other medicines work. These include:

Probenecid (used to treat gout).

Tell your doctor or pharmacist if you are taking any of these.

Pregnancy and breast-feeding

Vetam® is not recommended for use during pregnancy.

Tell your doctor if you are pregnant or planning to become pregnant.

Use a reliable method of contraception while you’re taking Vetam®, to prevent pregnancy.

If you do become pregnant during treatment with Vetam®, tell your doctor.

levetiracetam can be used during pregnancy, only if after careful assessment it is considered necessary by your doctor. You should not stop your treatment without discussing this with your doctor. A risk of birth defects for your unborn child cannot be completely excluded. levetiracetam has shown unwanted reproductive effects in animal studies.

Breast-feeding is not recommended during treatment with levetiracetam. The ingredients can pass into your breast milk. Talk to your doctor about this.

Driving and using machines

Vetam® can make you feel drowsy or sleepy and have other side effects that make you less alert. This is more likely at the beginning of treatment or after an increase in the dose.

Don’t drive or use machines unless you are sure you’re not affected.

 


How much to take

Always take Vetam® exactly as your doctor has told you to. Check with your doctor or pharmacist if you’re not sure.

Take the number of tablets following your doctor’s instructions.

Vetam® must be taken twice a day, once in the morning and once in the evening, at about the same time each day.

Monotherapy

Monotherapy in adults and adolescents (from 16 years of age)

When you will first start taking Vetam®, your doctor will prescribe you a lower dose during first 2 weeks of treatment, before giving you the lowest general dose.

The usual starting dose of Vetam® is 250 mg twice daily. Your doctor will increase your dose to 500 mg, twice daily after two weeks of treatment.

Your doctor may decide to further increase your dose to a maximum of 1500 mg, twice daily - depending on how you respond to the medicine.

Add-on therapy

Add-on therapy in adults and adolescents (12 to 17 years) weighing 50 kg or more

The usual starting dose of Vetam® is 500 mg twice daily. Your doctor may decide to gradually increase your dose to a maximum of 1500 mg, twice daily - depending on how you respond to the medicine.

Patients with kidney problems

Your doctor will decide on the correct dose of Vetam® for you/your child depending on kidney function and the body weight.

How to take

Swallow Vetam® tablet(s) with a sufficient quantity of liquid (for example a glass of water). You can take Vetam® with or without food. After oral administration the bitter taste of levetiracetam may be experienced.

If you forget to take Vetam®

Don’t take an extra dose to make up for a missed dose. Contact your doctor if you have missed one or more doses.

If you take too much Vetam®

If you take more Vetam® than you should you may be more likely to feel drowsy, agitated or have other side effects such as decrease of alertness, aggression, shallow breathing and loss of consciousness (coma).

Don’t delay. Contact your doctor or your nearest hospital emergency department immediately. If possible, show them the Vetam® pack.

Don’t stop Vetam® without advice

Take Vetam® for as long as your doctor recommends. Don’t stop unless your doctor advises you to. If you are suffering from epilepsy abruptly stopping your medicine may increase your fits (seizures).

If stopping treatment, Vetam® should be discontinued gradually. Your doctor will instruct you about the gradual withdrawal of Vetam®.

Ask your doctor or pharmacist if you have any questions on the use of this product.

 


Like all medicines, Vetam® can cause side effects, but not everybody gets them.

Conditions you need to look out for

Severe allergic reactions (These are rare in people taking levetiracetam)

Signs include:

Raised and itchy rash (hives).

Swelling, sometimes of the face or mouth (angioedema), causing difficulty in breathing.

Collapse or loss of consciousness.

Serious skin reactions (These are rare in people taking levetiracetam)

Signs include:

Skin rash, which may blister, and looks like small targets (central dark spots surrounded by a paler area, with a dark ring around the edge - erythema multiforme).

A widespread rash with blisters and peeling skin, particularly around the mouth, nose, eyes and genitals (Stevens Johnson Syndrome).

Extensive peeling of the skin on much of the body surface – (toxic epidermal necrolysis).

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) (These are rare in people taking levetiracetam)

Signs include:

Flu-like symptoms and a rash on the face followed by an extended rash with a high temperature.

Enlarged lymph nodes.

Increased levels of liver enzymes seen in blood tests and an increase in a type of white blood cell (eosinophilia).

Sudden decrease of kidney function (This is rare in people taking levetiracetam)

Signs include:

Low urine volume.

Tiredness, nausea, vomiting.

Confusion.

Swelling in the legs, ankles or feet.

Encephalopathy (degenerative disease of the brain) (This is rare (and may occur at the beginning of the treatment) in people taking levetiracetam)

Signs include:

Serious mental changes or signs of confusion.

Feeling drowsy (somnolence).

Loss of memory (amnesia), memory impairment (forgetfulness).

Abnormal behavior.

Other neurological signs including involuntary or uncontrolled movements.

Depression

This is common in people taking levetiracetam.

Suicidal thoughts

These are uncommon in people taking levetiracetam.  

Get medical help immediately if you get these symptoms.

Very common side effects (These may affect more than 1 in 10 people):

Inflammation of the nasopharynx (nasopharyngitis).

Feeling drowsy (somnolence).

Headache.

Common side effects (These may affect up to 1 in 10 people):

Loss of appetite (anorexia) - especially if you take another drug called topiramate.

Depression, hostility or aggression, anxiety, difficulty in sleeping, nervousness or irritability.

Fits (seizures), balance disorder, dizziness, abnormal drowsiness (lethargy), and tremor.

Spinning sensation (vertigo).

Cough.

Stomach pain, diarrhea, indigestion, vomiting, feeling sick (nausea).

Rash.

Feeling weak or lack of energy.

Uncommon side effects (These may affect up to 1 in 100 people):

Decreased or increased weight.

Suicide attempt and suicidal ideation, mental disorder, abnormal behaviour, seeing or hearing things that are not really there (hallucination), anger, confusion, panic attack, emotional instability/mood swings, and agitation.

Loss of memory, memory impairment (forgetfulness), abnormal coordination or loss of coordinated bodily movements, tingling or numbness of the hands or feet, disturbance in attention (loss of concentration).

Double vision, blurred vision.

Unusual hair loss or thinning, eczema, itching.

Muscle weakness, muscle pain.

Injury.

Uncommon side effects that may show up in blood tests:

Decrease in number of blood platelets - cells that help blood to clot (thrombocytopenia).

Decrease in the number of white blood cells (leucopenia).

Elevated/abnormal values in a liver function test.

 Rare side effects (These may affect up to 1 in 1,000 people):

Infection.

Allergic reaction.

Drug-induced hypersensitivity reaction that includes fever, rash, and blood abnormalities.

Suicide, personality disorders (behavioural problems), abnormal thinking.

Uncontrollable muscle spasms affecting the eyes, head, neck and body, uncontrollable movements, hyperactivity (unusually overactive).

Inflammation of the pancreas.

Liver failure, inflammation of the liver.

Erythema multiforme, Stevens Johnson Syndrome, toxic epidermal necrolysis.

Acute kidney injury.

Rhabdomyolysis (breakdown of muscle tissue) and associated blood creatine phosphokinase increase. Prevalence is significantly higher in Japanese patients when compared to non-Japanese patients.

Limp or difficulty walking.

Rare side effects that may show up in blood tests:

Decrease in number of all types blood cells.

Decrease in sodium in the blood.

Tell your doctor or pharmacist if any of the side effects listed becomes severe or troublesome, or if you notice any side effects not listed in this leaflet.

 


Keep out of the reach and sight of children.

Do not use Vetam® tablets after the expiry date (EXP) which is stated on the blister and the carton.

The expiry date refers to the last day of that month.

Vetam® tablets: Store below 30°C.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.


The active substance is levetiracetam.

The other ingredients are dibasic calcium phosphate, crospovidone, hydroxypropyl cellulose, microcrystalline cellulose, Opadry II white, yellow iron oxide, purified water.


Vetam® 500 mg: Yellow oval biconvex film coated tablet engraved with C33 on one side and plain on the other side, presented in HDPE bottles, intended for oral use. Pack size: 30 Film Coated tablets/HDPE bottle. Vetam® 1000 mg: White oval biconvex film coated tablet engraved with C35 on one face, presented in HDPE bottles, intended for oral use. Pack size: 30 Film Coated tablets/HDPE bottle. To report any side effect(s): • Saudi Arabia: The National Pharmacovigilance Center (NPC): SFDA Call Center: 19999 E-mail: npc.drug@sfda.gov.sa Website: https://ade.sfda.gov.sa • Other GCC States: Please contact the relevant competent authority.

Med City Pharma-KSA.

Tel: 00966920003288

Fax: 00966126358138

Mobile: 00966555786968

P.O .Box: 42512 - Jeddah 21551

E-mail: MD.admin@axantia.com

 

This leaflet does not contain all the information about your medicine. If you have any questions or are not sure about anything, ask your doctor or pharmacist.

 


This leaflet was last revised in 03/2022
  نشرة الدواء تحت مراجعة الهيئة العامة للغذاء والدواء (اقرأ هذه النشرة بعناية قبل البدء في استخدام هذا المنتج لأنه يحتوي على معلومات مهمة لك)

يحتوي ڨيتام® على المادة الفعالة ليفيتيراسيتام‏‫. والتي تنتمي إلى الأدوية المضادة للصرع، والتي تستعمل لعلاج نوبات ظهور الأعراض المفاجئة (نوبات الصرع).

يستعمل ڨيتام® بمفرده لعلاج:

نوبات الصرع جزئية المنشأ مع أو بدون الانتشار ضمن الدماغ (شكل من أشكال الصرع الذي يؤثر فيه نوبات ظهور الأعراض المفاجئة بشكل مبدئي على جانب واحد من الدماغ، ولكن قد تمتد بعد ذلك إلى مناطق أكبر على جانبي الدماغ) - عند البالغين والمراهقين من عمر 16 عاما الذين تم تشخيص إصابتهم حديثًا بالصرع.

كعلاج إضافي مع الأدوية الأخرى المضادة للصرع، يستعمل ڨيتام® لعلاج:

نوبات الصرع جزئية المنشأ مع أو بدون الانتشار ضمن الدماغ  عند البالغين، المراهقين، الأطفال والرضع من عمر شهر واحد ويعانون من الصرع.

نوبات الصرع الارتجاجية العضلية (حركات سريعة  قصيرة تشبه الصدمة لعضلة أو مجموعة من العضلات) عند البالغين والمراهقين من عمر 12 عاما ويعانون من نوبات الصرع الإرتجاجية العضلية الصبيانية.

نوبات الصرع الإرتجاجية التوترية الأولية (نوبات ظهور أعراض مفاجئة كبرى، بما في ذلك فقدان الوعي) عند البالغين والمراهقين من عمر 12 عاما والذين يعانون من الصرع الذاتي الذي ينتشر ضمن الدماغ (نوع من الصرع الذي يُعتقد أنه يرجع لسبب وراثي).

 

يجب عدم تناول ڨيتام®  في الحالات التالية:

إذا كنت تعاني من تحسس (فرط التحسس) ليفيتيراسيتام، مشتقات البيروليدون الأخرى أو لأي مكونات أخرى في ڨيتام®.

إذا كنت تعتقد أن أي من ذلك ينطبق عليك، لا تتناول ڨيتام® إلى أن يتم التأكد من طبيبك.

يجب اتخاذ احتياطات خاصة عند استعمال ڨيتام®

قبل تناول ڨيتام®، يحتاج طبيبك إلى معرفة ما يلي:

إذا كنت تعاني من مشاكل في الكلى أو أمراض حادة في الكبد، قد يحتاج طبيبك إلى تعديل جرعة ڨيتام®.

إذا كنتِ حامل أو مرضعة، تعتقدين بأنك حامل أو تخططين للحمل.

إذا كنت تتناول أي أدوية أخرى.

إذا كان عمرك يزيد عن 65 عاما.

تأكد من الطبيب إذا كنت تعتقد أن أي من هذه تنطبق عليك. سوف يقرر طبيبك إذا كان ڨيتام® مناسبًا لك.

الأطفال و المراهقون

لا يوصى باستعمال أقراص ڨيتام® المغلفة للأطفال الذين تقل أعمارهم عن 6 أعوام.

محلول ليفيتيراسيتام عن طريق الفم هو الشكل الأنسب للاستعمال للرضع والأطفال الذين تقل أعمارهم عن 6 أعوام.

لا يوصى باستعمال ڨيتام® لعلاج الأطفال والمراهقين الذين تقل أعمارهم عن 16عاما لوحدة (كعلاج أحادي).

أثناء فترة تناول ڨيتام®

إذا لاحظت أي بطء في النمو أو بلوغ غير متوقع لطفلك، اتصل مع طبيبك.

عدد قليل من الأشخاص الذين خضعوا للعلاج بمضادات الصرع مثل ﻟفيتيراسيتام، فكروا بإيذاء أو قتل أنفسهم. إذا عانيت أي من هذه الأفكار، اتصل مع طبيبك فورا.

حالات تحتاج إلى الانتباه

قد يؤدي ڨيتام® إلى تفاقم بعض الحالات الموجودة سوءاً، أو يسبب آثار جانبية خطيرة، مثل تفاعلات تحسسية حادة، تفاعلات الجلد الخطيرة، طفح جلدي ناتج عن استعمال بعض الأدوية يرافقة ظهور كثرة الحمضات وأعراض جهازية، قصور مفاجئ في وظائف الكلى، الاعتلال الدماغي (مرض تنكسي في الدماغ)، الاكتئاب أو الأفكار الانتحارية. ل??ذا يجب عليك الانتباه لأعراض معينة خلال فترة تناول ڨيتام®، للحد من خطر حدوث أي مشاكل.

الأدوية الأخرى و ڨيتام®

أخبر طبيبك أو الصيدلي إذا كنت تتناول أي أدوية أخرى، تناولت مؤخراً أو بدأت بتناول أدوية جديدة. بما في ذلك الأدوية التي يتم الحصول عليها بدون وصفة طبية.

تجنب تناول ماكروجول (دواء يستعمل كملين) لمدة ساعة قبل تناول ڨيتام® وساعة بعد تناوله لأن هذا قد يؤدي إلى فقدان تأثيره.

سيتم مراقبتك جيدا إذا كنت تتناول ڨيتام® مع الأدوية الأخرى:

ميثوتريكسات (يستعمل لعلاج أنواع معينة من السرطان).

قد تؤثر بعض الأدوية الأخرى على طريقة عمل ڨيتام® أو يمكن أن تزيد من احتمالية إصابتك بآثار جانبية. يمكن أن يؤثر ڨيتام® أيضا على طريقة عمل بعض الأدوية الأخرى. وتشمل هذه الأدوية:

بروبينيسيد (يستعمل لعلاج النقرس‏).

أخبر طبيبك أو الصيدلي إذا كنت تتناول أي من هذه الأدوية.

الحمل والرضاعة الطبيعية

لا يوصى بتناول ڨيتام® أثناء فترة الحمل.

أخبري الطبيب إذا كنتِ حامل أو تخططين للحمل.

استعملي طريقة موثوقة لمنع الحمل أثناء تناول ڨيتام®، لمنع حدوث الحمل.

إذا أصبحتِ حامل أثناء العلاج باستعمال ڨيتام®، أخبري طبيبك.

من الممكن استعمال ﻟفيتيراسيتام خلال فترة الحمل فقط إذا تم اعتبار استعماله ضروري بعد تقييم جيد من قبل الطبيب. يجب عدم التوقف عن العلاج بدون مناقشة هذا مع طبيبك. لا يمكن استبعاد خطر ولادة جنين مصاب بتشوهات خلقية بشكل كامل.

أظهر ﻟفيتيراسيتام آثار غير مرغوب فيها تتعلق بالإنجاب في الدراسات التي تم إجراؤها على الحيوانات.

لا يوصى بالرضاعة الطبيعية أثناء العلاج بلفيتيراسيتام. حيث يمكن أن تفرز المكونات إلى حليب الثدي. تحدثي مع طبيبك عن هذا.

القيادة واستخدام الآلات

قد يجعلك ڨيتام® تشعر بالخمول أو النعاس تعاني من آثار جانبية أخرى التي تجعلك أقل انتباها. وهذا أكثر احتمالا في بداية العلاج أو بعد زيادة الجرعة.

تجنب القيادة أو استخدام الآلات ما لم تكن متاكدا أنك لا تتأثر.

 

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دائماً تناول هذا الدواء تماماً كما اخبرك طبيبك أو الصيدلي. تاكد من طبيبك أو الصيدلي إذا لم تكن متاكدا.

تناول عدد الأقراص وفقًا لتعليمات طبيبك.

يجب تناول ڨيتام® مرتين في اليوم، مرة في الصباح ومرة في المساء، في نفس الوقت تقريبًا كل يوم.

العلاج الأحادي

العلاج الأحادي للبالغين والمراهقين (من عمر 16 عام)

عندما ستبدأ بتناول ڨيتام®، سيصف لك الطبيب أقل جرعة خلال أول أسبوعين من العلاج، قبل إعطائك أقل جرعة عامة.

الجرعة المعتادة الابتدائية من ڨيتام® هي 250 ملغم مرتين يوميا. سيقوم طبيبك بزيادة الجرعة إلى 500 ملغم، مرتين يوميا بعد أسبوعين من العلاج.

قد يقرر طبيبك زيادة الجرعة زيادة إضافية للوصول  إلى الجرعة القصوى والتي تبلغ 1500 ملغم مرتين يوميا – اعتمادا على استجابتك للدواء.

العلاج الإضافي

العلاج الإضافي للبالغين والمراهقين (من عمر 12 إلى 17عام) الذين تبلغ أوزانهم 50  كغم أو أكثر.

الجرعة المعتادة الابتدائية من ڨيتام® هي500  ملغم مرتين يوميا. قد يقرر طبيبك زيادة الجرعة تدريجيًا للوصول  إلى الجرعة القصوى والتي تبلغ 1500 ملغم مرتين يوميا – اعتمادا على استجابتك للدواء.

المرضى الذين يعانون من مشاكل في الكلى

سوف يقرر طبيبك الجرعة الصحيحة من ڨيتام® لك/لطفلك حسب وظائف الكلى و وزن الجسم.

كيفية تناول الجرعة

قم بتناول قرص/أقراص ڨيتام® مع شرب كمية كافية من السوائل (على سبيل المثال كوب من الماء). يمكنك تناول ڨيتام® مع أو بدون تناول الطعام. قد تشعر بمذاق مر ناتج عن لفيتيراسيتام بعد تناوله عن طريق الفم.

إذا نسيت تناول جرعة ڨيتام®

لا تتناول جرعة إضافية لتعويض الجرعة التي نسيتها. اتصل مع طبيبك إذا نسيت جرعة أو أكثر.

إذا تناولت ڨيتام® أكثر مما يجب

إذا تناولت ڨيتام® أكثر مما يجب، من المحتمل أكثر أن تشعر بالنعاس، التهيج‏ أو أن تعاني من آثار جانبية أخرى، مثل انخفاض الانتباه، العدوانية، التنفس الضحل وفقدان الوعي (غيبوبة).

لا تتأخر. اتصل مع الطبيب أو قسم الطوارئ في أقرب مستشفى على الفور. إذا كان ممكنا أن تريهم عبوة ڨيتام®.

لا تتوقف عن تناول ڨيتام® بدون استشارة الطبيب

تناول ڨيتام® طالما يوصي به الطبيب. لا تتوقف عن تناوله ما لم يخبرك الطبيب بذلك. إذا كنت تعاني من الصرع، فإن التوقف عن تناول الدواء بشكل مفاجئ قد يزيد من نوبات ظهور الأعراض المفاجئة (نوبات الصرع).

في حالة التوقف عن العلاج، يجب التوقف عن تناول ڨيتام® تدريجيًا. سيقوم طبيبك بإرشادك حول التوقف عن تناول ڨيتام® تدريجيًا.

اسأل طبيبك أو الصيدلي إذا كان لديك أي أسئلة إضافية حول استعمال هذا المستحضر.

 

مثل جميع الأدوية، قد يسبب هذا الدواء آثار جانبية، على الرغم من عدم حدوثها لدى الجميع.

حالات تحتاج إلى الانتباه

تفاعلات تحسسية حادة (هذه التفاعلات نادرة عند الأشخاص الذين يتناولون ليفيتيراسيتام)

تتضمن العلامات:

طفح جلدي بارز عن سطح الجلد و يسبب الحكة (شرى).

تورم، في بعض الأحيان في الوجه أو الفم (وذمة وعائية)، يؤدي إلى صعوبة في التنفس.

وهط أو فقدان الوعي.

تفاعلات جلدية خطيرة (هذه التفاعلات نادرة عند الأشخاص الذين يتناولون ليفيتيراسيتام)

تتضمن العلامات:

طفح جلدي، الذي قد يشكل نفطات و يبدو كبقع صغيرة (بقع مركزية داكنة محاطة بمنطقة ذات لون أكثر شحوبا، مع حلقة داكنة حول الحافة - حمامى متعددة الأشكال).

طفح منتشر مع نفطات و تقشير الجلد، خصوصاً حول الفم، الأنف، العيون والأعضاء التناسلية (متلازمة ستيفين-جونسون).

تقشر واسع للجلد على مساحة كبيرة من سطح الجسم (تحلل نخري سام في البشرة).

طفح جلدي ناتج عن استعمال بعض الأدوية يرافقة ظهور كثرة الحمضات و أعراض جهازية (هذه التفاعلات نادرة عند الأشخاص الذين يتناولون ليفيتيراسيتام)

العلامات بما في ذلك:

أعراض تشبه أعراض الإنفلونزا وطفح على الوجه يتبعه ظهور طفح جلدي منتشر مع ارتفاع في درجة الحرارة.

تضخم العقد الليمفاوية.

زيادة مستويات إنزيمات الكبد التي تظهر في فحوصات الدم وزيادة في نوع خلايا الدم البيضاء (فرط الحمضات).

قصور مفاجئ في وظائف الكلى (هذا نادر الحدوث عند الأشخاص الذين يتناولون ليفيتيراسيتام) تتضمن العلامات:

انخفاض كمية البول.

الشعور بالتعب، بالغثيان، القيء

الارتباك.

تورم في الساقين، الكاحلين أو القدمين.

اعتلال دماغي (مرض تنكسي في الدماغ) (هذا نادر الحدوث (وقد يحدث في بداية العلاج) عند الأشخاص الذين يتناولون ليفيتيراسيتام)

تتضمن العلامات:

تغيرات عقلية خطيرة أو علامات الارتباك.

الشعور بالنعاس.

فقدان الذاكرة، ضعف الذاكرة (النسيان).

سلوك غير طبيعي.

علامات عصبية أخرى، بما في ذلك حركات لا إرادية أو غير مضبوطة.

الاكتئاب (هذا شائع لدى الأشخاص الذين يتناولون ليفيتيراسيتام).

 

أفكار انتحارية (هذه شائعة عند الأشخاص الذين يتناولون ليفيتيراسيتام). 

اطلب المساعدة الطبية فورا إذا حصل لديك هذه الأعراض.

آثار جانبية شائعة جدًا (قد تؤثر على أكثر من 1 من كل 10 أشخاص):

التهاب البلعوم الأنفي.

الشعور بالنعاس.

صداع.

آثار جانبية شائعة (قد تؤثر هذه على 1 أو أقل من كل 10 أشخاص):

فقدان الشهية - خاصةً إذا كنت تتناول دواءً آخر يسمى توبيراميت.

الاكتئاب، العدوانية، القلق، صعوبة في النوم، العصبية أو التهيج.

نوبات ظهور أعراض مفاجئة (نوبات صرع) ا?????ضطراب التوازن، الشعور بالدوار، شعور غير طبيعي بالنعاس (خمول) و رعاش (رجفان لا إرادي).

الشعور بالدوران (دوخة).

السعال.

ألم في المعدة، الإسهال، عسر الهضم، القيء، الشعور بالغثيان.

الطفح الجلدي.

الشعور بالضعف أو فقدان الطاقة.

آثار جانبية غير شائعة (قد تؤثر هذه على 1 أو أقل من كل 100 شخص):

زيادة أو نقصان في الوزن.

محاولة الانتحار و التفكير به، اضطراب عقلي، سلوك غير طبيعي، رؤية أو سماع أشياء غير موجودة في الحقيقة (هلوسة)، شعور بالغضب، ارتباك، نوبة هلع، عدم الاستقرار العاطفي/تقلبات المزاج و التهيج.

فقدان الذاكرة، ضعف الذاكرة (النسيان)، التناسق غير الطبيعي أو فقدان الحركات الجسدية المتناسقة ، الإحساس بوخز خفيف أو تنميل في اليدين أو القدمين، اضطراب في الانتباه (فقدان التركيز).

ازدواجية الرؤية، ضبابية الرؤية.

تساقط غير طبيعي أو ترقق الشعر، الإكزيما، الحكة.

ضعف العضلات، ألم العضلات.

إصابات.

آثار جانبية غير شائعة التي قد تظهر في فحوصات الدم:

نقص في عدد الصفيحات الدموية -هي خلايا تساعد في تجلط الدم (نقص الصفيحات الدموية).

نقص في عدد خلايا الدم البيضاء (قلة الكريات البيض).

قيم مرتفعة/غير طبيعية في فحص وظائف الكبد.

آثار جانبية نادرة (قد تؤثر هذه على 1 أو أقل من كل 1000 شخص)

الالتهابات.

تفاعلات تحسسية.

تفاعلات فرط التحسس التي يسببها الدواء، بما في ذلك الحمى، الطفح الجلدي و اضطرابات الدم غير الطبيعية.

الانتحار، اضطرابات في الشخصية (مشاكل سلوكية)، تفكير غير طبيعي.

تشنجات عضلية لا يمكن السيطرة عليها تؤثر على العينين، الرأس، الرقبة والجسم، حركات لا يمكن السيطرة عليها، فرط النشاط (فرط نشاط غير معتاد).

التهاب البنكرياس.

قصور وظيفة الكبد، التهاب الكبد.

حمامى عديدة الأشكال، متلازمة ستيفن- جونسون، تحلل نخري سام في البشرة.

إصابة حادة في الكلى.

تحلل العضلات الهيكلية المخططة (تحلل الأنسجة العضلية) و ما يرافقة من ارتفاع تركيز إنزيم كرياتين فوسفوكاينيز في الدم المرتبط بذلك. والذي يكون معدل انتشاره أعلى بشكل ملحوظ بين المرضى اليابانيين مقارنة بالمرضى غير اليابانيين.

عرج أو صعوبة في المشي.

آثار جانبية نادرة التي قد تظهر في فحوصات الدم:

نقص في عدد جميع أنواع خلايا الدم.

انخفاض في مستوى الصوديوم في الدم.

 

أخبر الطبيب أو الصيدلي إذا اصبحت أي من الآثار الجانبية المذكورة حادة أو مزعجة، أو إذا لاحظت أية آثار جانبية غير مذكورة في هذه النشرة.

 

يحفظ بعيدا عن متناول الأطفال و نظرهم.

لا تستخدم هذا الدواء بعد تاريخ انتهاء الصلاحية المذكورعلى الملصق و العلبة الخارجية.

تاريخ الانتهاء يشير إلى اليوم الأخير من ذلك الشهر.

يحفظ ڨيتام® أقراص في درجة حرارة دون 30°م.

يجب أن لا يتم التخلص من الأدوية عن طريق مياه الصرف الصحي أو النفايات المنزلية.اسأل الصيدلي عن كيفية التخلص من الأدوية التي لم تعد مطلوبة.وسوف تساعد هذه التدابير في حماية البيئة.

 

المادة الفعالة هي ليفيتيراسيتام.

المكونات الأخرى هي : كالسيوم فوسفات ثنائي القاعدة، كروسبوفيدون، هيدروكسي بروبيل سيليلوز، ميكروكريستالين سيليلوز، أوبادري II أبيض، أكسيد الحديد الأصفر، ماء نقي.

أقراص ڨيتام® 500 ملغم: أقراص مغلفة بيضاوية الشكل ذات لون أصفر، محدبة الوجهين، محفور على أحد الأوجه C33، معبأة في عبوات بولي إيثيلين عالي الكثافة، معدة للاستعمال عن طريق الفم.

حجم العبوة: 30 قرص مغلف/عبوة بولي إيثيلين عالي الكثافة.

أقراص ڨيتام® 1000 ملغم: أقراص مغلفة بيضاوية الشكل ذات لون أبيض، محدبة الوجهين، محفور على أحد الأوجه C35، معبأة في عبوات بولي إيثيلين عالي الكثافة، معدة للاستعمال عن طريق الفم.

حجم العبوة: 30 قرص مغلف/عبوة بولي إيثيلين عالي الكثافة.

 

للإبلاغ عن أي أعراض جانبية:

المملكة العربية السعودية:

المركز الوطني للتيقظ الدوائي:

مركز الاتصال الموحد: 19999

البريد الالكتروني: npc.drug@sfda.gov.sa

الموقع الالكتروني: https://ade.sfda.gov.sa

دول الخليج العربي الأخرى:

الرجاء الاتصال بالجهات الوطنية في كل دولة.

 

مدينة الدواء للصناعات الدوائية - المملكة العربية السعودية.

الهاتف:  00966920003288 

فاكس: 00966920003288

جوال: 00966920003288

ص.ب: 42512 – جدة 21551

البريد الإلكتروني: MD.admin@axantia.com

 

هذه النشرة لا تحتوي على جميع المعلومات عن المستحضر. إذا كان لديك أية أسئلة أو لم تكن متأكدا من أي شيء، اسأل طبيبك أو الصيدلي.

 

تم تنقيح هذه النشرة في 03/2022
 Read this leaflet carefully before you start using this product as it contains important information for you

Vetam® 500 mg Film Coated Tablets. Vetam® 1000mg Film Coated Tablets. Levetiracetam 500mg Film Coated Tablets. Levetiracetam 1000mg Film Coated Tablets.

Vetam® 500 mg: Each film coated tablet contains 500 mg of levetiracetam. Vetam® 1000 mg: Each film coated tablet contains 1000 mg of levetiracetam. For a full list of excipients: see section 6.1

Film Coated Tablets. Vetam® 500 mg: Yellow oval biconvex film coated tablet engraved with C33 on one side and plain on the other side, intended for oral use. Vetam®1000 mg: White oval biconvex film coated tablet engraved with C35 on one face, intended for oral use.

Levetiracetam is indicated as monotherapy in the treatment of:

·         Partial onset seizures with or without secondary generalisation in adults and adolescents from 16 years of age with newly diagnosed epilepsy.

Levetiracetam is indicated as adjunctive therapy in the treatment of:

·         partial onset seizures with or without secondary generalisation in adults, adolescents, children and infants from 1 month of age with epilepsy.

·         Myoclonic seizures in adults and adolescents from 12 years of age with juvenile myoclonic epilepsy.

·         Primary generalised tonic-clonic seizures in adults and adolescents from 12 years of age with idiopathic generalised epilepsy.


The film-coated tablets must be taken orally, swallowed with a sufficient quantity of liquid and may be taken with or without food. After oral administration the bitter taste of levetiracetam may be experienced. The daily dose is administered in two equally divided doses.

Route of Administration

For oral use.

Adults

·         Monotherapy

Adults and adolescents from 16 years of age

The recommended starting dose is 250 mg twice daily which should be increased to an initial therapeutic dose of 500 mg twice daily after two weeks. The dose can be further increased by 250 mg twice daily every two weeks depending upon the clinical response. The maximum dose is 1500 mg twice daily.

·         Add-on therapy

Adults (≥18 years) and adolescents (12 to 17 years) weighing 50 kg or more

The initial therapeutic dose is 500 mg twice daily. This dose can be started on the first day of treatment.

Depending upon the clinical response and tolerability, the daily dose can be increased up to 1500 mg twice daily. Dose changes can be made in 500 mg twice daily increases or decreases every two to four weeks.

Children

The physician should prescribe the most appropriate pharmaceutical form, presentation and strength according to age, weight and dose.

The tablet formulation is not adapted for use in infants and children under the age of 6 years. Levetiracetam oral solution is the preferred formulation for use in this population. In addition, the available dose strengths of the tablets are not appropriate for initial treatment in children weighing less than 25 kg, for patients unable to swallow tablets or for the administration of doses below 250 mg. In all of the above cases levetiracetam oral solution should be used.

·         Monotherapy

The safety and efficacy of levetiracetam in children and adolescents below 16 years as monotherapy treatment have not been established.

There are no data available.

·         Add-on therapy

Add-on therapy for infants aged from 6 to 23 months, children (2 to 11 years) and adolescents (12 to 17 years) weighing less than 50 kg

Levetiracetam oral solution is the preferred formulation for use in infants and children under the age of 6 years.

For children 6 years and above, levetiracetam oral solution should be used for doses under 250 mg, for doses not multiple of 250 mg when dosing recommendation is not achievable by taking multiple tablets and for patients unable to swallow tablets.

The initial therapeutic dose is 10 mg/kg twice daily.

Depending upon the clinical response and tolerability, the dose can be increased up to 30 mg/kg twice daily. Dose changes should not exceed increases or decreases of 10 mg/kg twice daily every two weeks. The lowest effective dose should be used.

Dose in children 50 kg or greater is the same as in adults.

Elderly

Adjustment of the dose is recommended in elderly patients with compromised renal function.

Renal impairment

The daily dose must be individualised according to renal function (see Section Warnings and Precautions).

For adult patients, refer to the following table and adjust the dose as indicated. To use this dosing table, an estimate of the patient's creatinine clearance (CLcr) in ml/min is needed. The CLcr in ml/min may be estimated from serum creatinine (mg/dl) determination, for adults and adolescents weighing 50 kg or more, using the following formula:

                           [140- age (years)] x weight (kg)

CLcr (ml/min) = -------------------------------------------- (x 0.85 for women)

                             72 x serum creatinine (mg/dl)

 

Then CLcr is adjusted for body surface area (BSA) as follows:

                                 

                                            CLcr (ml/min)

CLcr (ml/min/1.73 m2) = -------------------------- x 1.73

                                           BSA subject (m2)

Dosing adjustment for adult and adolescent patients weighing more than 50kg with impaired renal function

Group

Creatinine clearance 

(ml/min/1.73m2)

Dosage and

frequency

Normal

> 80

500 to 1500 mg twice daily

Mild

50-79

500 to 1000 mg twice daily

Moderate

30-49

250 to 750 mg twice daily

Severe

< 30

250 to 500 mg twice daily

End-stage renal

disease patients

undergoing dialysis(1)

-

500 to 1000 mg once daily (2)

(1) A 750 mg loading dose is recommended on the first day of treatment with levetiracetam.

(2) Following dialysis, a 250 to 500 mg supplemental dose is recommended.

For children with renal impairment, levetiracetam dose needs to be adjusted based on the renal function as levetiracetam clearance is related to renal function.

This recommendation is based on a study in adult renally impaired patients.

The CLcr in ml/min/1.73 m2 may be estimated from serum creatinine (mg/dl) determination using, for young adolescents and children using the following formula (Schwartz formula):

                                              Height (cm) x ks

CLcr (ml/min/1.73 m2) = ---------------------------------------

                                           Serum Creatinine (mg/dl)

 

ks= 0.45 in Term infants to 1 year old; ks= 0.55 in Children to less than 13 years and in adolescent female; ks= 0.7 in adolescent male

Dosing adjustment for infants, children and adolescents patients weighing less than 50 kg with impaired renal function

Group

Creatinine clearance

(ml/min/1.73m2)

Dosage and frequency (1)

  

Infants 1 to

less than 6

months

Infants 6 to 23 months,

children and adolescents

weighing less than 50 kg

Normal

> 80

7 to 21

mg/kg (0.07

to 0.21

ml/kg) twice

daily

10 to 30 mg/kg (0.10 to 0.30

ml/kg) twice daily

Mild

50-79

7 to 14

mg/kg (0.07

to 0.14

ml/kg) twice

daily

10 to 20 mg/kg (0.10 to 0.20 ml/kg) twice daily

Moderate

30-49

3.5 to 10.5

mg/kg(0.035 to 0.105

ml/kg) twice daily

5 to 15 mg/kg (0.05 to 0.15 ml/kg) twice daily

Severe

< 30

3.5 to 7

mg/kg (0.035 to

0.07 ml/kg)

twice daily

5 to 10 mg/kg (0.05 to 0.10 ml/kg) twice daily

End-stage renal disease patients undergoing dialysis

-

7 to 14

mg/kg (0.07 to 0.14

ml/kg) once

daily (2)(4)

10 to 20 mg/kg (0.10 to 0.20 ml/kg) once daily (3) (5)

 

(1) Levetiracetam oral solution should be used for doses under 250 mg, for doses not multiple of 250 mg when dosing recommendation is not achievable by taking multiple tablets and for patients unable to swallow tablets.

(2) A 10.5 mg/kg (0.105 ml/kg) loading dose is recommended on the first day of treatment with levetiracetam.

(3) A 15 mg/kg (0.15 ml/kg) loading dose is recommended on the first day of treatment with levetiracetam.

(4) Following dialysis, a 3.5 to 7 mg/kg (0.035 to 0.07 ml/kg) supplemental dose is recommended.

(5) Following dialysis, a 5 to 10 mg/kg (0.05 to 0.10 ml/kg) supplemental dose is recommended.

Hepatic impairment

No dose adjustment is needed in patients with mild to moderate hepatic impairment. In patients with severe hepatic impairment, the creatinine clearance may underestimate the renal insufficiency. Therefore a 50 % reduction of the daily maintenance dose is recommended when the creatinine clearance is < 60 ml/min/1.73 m2.

 


Levetiracetam is contraindicated in: • Hypersensitivity to the active substance or other pyrrolidone derivatives or to any of the excipients.

Discontinuation

If levetiracetam has to be discontinued it is recommended to withdraw it gradually (e.g. in adults and adolescents weighing more than 50 kg: 500 mg decreases twice daily every two to four weeks; in infants older than 6 months, children and adolescents weighing less than 50 kg: dose decrease should not exceed 10 mg/kg twice daily every two weeks; in infants less than 6 months: dose decrease should not exceed 7 mg/kg twice daily every two weeks).

Renal or hepatic impairment

The administration of levetiracetam to patients with renal impairment may require dose adjustment. In patients with severely impaired hepatic function, assessment of renal function is recommended before dose selection.

Acute kidney injury

The use of levetiracetam has been very rarely associated with acute kidney injury, with a time to onset ranging from a few days to several months.

Blood cell counts

Rare cases of decreased blood cell counts (neutropenia, agranulocytosis, leucopenia, thrombocytopenia and pancytopenia) have been described in association with levetiracetam administration, generally at the beginning of the treatment. Complete blood cell counts are advised in patients experiencing important weakness, pyrexia, recurrent infections or coagulation disorders (see Section Adverse Reactions).

Depression and/or suicidal ideation

Suicide, suicide attempt, suicidal ideation and behaviour have been reported in patients treated with anti-epileptic agents (including levetiracetam). A meta-analysis of randomized placebo-controlled trials of anti-epileptic medicinal products has shown a small increased risk of suicidal thoughts and behaviour. The mechanism of this risk is not known.

Therefore patients should be monitored for signs of depression and/or suicidal ideation and behaviours and appropriate treatment should be considered. Patients (and caregivers of patients) should be advised to seek medical advice should signs of depression and/or suicidal ideation or behaviour emerge.

Paediatric population

The tablet formulation is not adapted for use in infants and children under the age of
6 years.

Available data in children did not suggest impact on growth and puberty. However, long term effects on learning, intelligence, growth, endocrine function, puberty and childbearing potential in children remain unknown.


·         Antiepileptic medicinal products

Pre-marketing data from clinical studies conducted in adults indicate that levetiracetam did not influence the serum concentrations of existing antiepileptic medicinal products (phenytoin, carbamazepine, valproic acid, phenobarbital, lamotrigine, gabapentin and primidone) and that these antiepileptic medicinal products did not influence the pharmacokinetics of levetiracetam.

As in adults, there is no evidence of clinically significant medicinal product interactions in paediatric patients receiving up to 60 mg/kg/day levetiracetam.

A retrospective assessment of pharmacokinetic interactions in children and adolescents with epilepsy (4 to 17 years) confirmed that adjunctive therapy with orally administered levetiracetam did not influence the steady-state serum concentrations of concomitantly administered carbamazepine and valproate. However, data suggested a 20 % higher levetiracetam clearance in children taking enzyme-inducing antiepileptic medicinal products. Dose adjustment is not required.

·         Probenecid

Probenecid (500 mg four times daily), a renal tubular secretion blocking agent, has been shown to inhibit the renal clearance of the primary metabolite, but not of levetiracetam. Nevertheless, the concentration of this metabolite remains low.

·         Methotrexate

Concomitant administration of levetiracetam and methotrexate has been reported to decrease methotrexate clearance, resulting in increased/prolonged blood methotrexate concentration to potentially toxic levels. Blood methotrexate and levetiracetam levels should be carefully monitored in patients treated concomitantly with the two drugs.

·         Oral contraceptives, digoxin and warfarin

 

·         Laxatives

There have been isolated reports of decreased levetiracetam efficacy when the osmotic laxative macrogol has been concomitantly administered with oral levetiracetam. Therefore, macrogol should not be taken orally for one hour before and for one hour after taking levetiracetam.

·         Food and alcohol

The extent of absorption of levetiracetam was not altered by food, but the rate of absorption was slightly reduced.

No data on the interaction of levetiracetam with alcohol are available.

 


No impact on fertility was detected in animal studies. No clinical data are available, potential risk for human is unknown.

Women of childbearing potential

Specialist advice should be given to women who are of childbearing potential. Treatment with levetiracetam should be reviewed when a woman is planning to become pregnant. As with all antiepileptic medicines, sudden discontinuation of levetiracetam should be avoided as this may lead to breakthrough seizures that could have serious consequences for the woman and the unborn child. Monotherapy should be preferred whenever possible because therapy with multiple antiepileptic medicines AEDs could be associated with a higher risk of congenital malformations than monotherapy, depending on the associated antiepileptics.

Pregnancy

A large amount of postmarketing data on pregnant women exposed to levetiracetam monotherapy (more than 1800, among which in more than 1500 exposure occurred during the first trimester) do not suggest an increase in the risk for major congenital malformations. Only limited evidence is available on the neurodevelopment of children exposed to levetiracetam monotherapy in utero. However, current epidemiological studies (on about 100 children) do not suggest an increased risk of neurodevelopmental disorders or delays.

Levetiracetam can be used during pregnancy, if after careful assessment it is considered clinically needed. In such case, the lowest effective dose is recommended.

Physiological changes during pregnancy may affect levetiracetam concentration. Decrease in levetiracetam plasma concentrations has been observed during pregnancy. This decrease is more pronounced during the third trimester (up to 60% of baseline concentration before pregnancy). Appropriate clinical management of pregnant women treated with levetiracetam should be ensured.

Lactation

Levetiracetam is excreted in human breast milk. Therefore, breast-feeding is not recommended.

However, if levetiracetam treatment is needed during breastfeeding, the benefit/ risk of the treatment should be weighed considering the importance of breastfeeding.

 


Levetiracetam has minor or moderate influence on the ability to drive and use machines.

Due to possible different individual sensitivity, some patients might experience somnolence or other central nervous system related symptoms, especially at the beginning of treatment or following a dose increase. Therefore, caution is recommended in those patients when performing skilled tasks, e.g. driving vehicles or operating machinery. Patients are advised not to drive or use machines until it is established that their ability to perform such activities is not affected.

 


Clinical Trial Data and Post Marketing Data

Summary of the safety profile

The adverse event profile presented below is based on the analysis of pooled placebo-controlled clinical trials with all indications studied, with a total of 3,416 patients treated with levetiracetam. These data are supplemented with the use of levetiracetam in corresponding open-label extension studies, as well as post-marketing experience. The most frequently reported adverse reactions were nasopharyngitis, somnolence, headache, fatigue and dizziness. The safety profile of levetiracetam is generally similar across age groups (adult and paediatric patients) and across the approved epilepsy indications.

Adverse drug reactions (ADRs) are listed below by MedDRA system organ class and by frequency.

Frequencies are defined as:

Very common ≥1/10

Common ≥1/100 to <1/10

Uncommon ≥1/1000 to <1/100

Rare ≥1/10000 to <1/1000

Very rare <1/10000

Not known (cannot be estimated from the available data).

·         Infections and infestations

- Very common: nasopharyngitis.

- Rare: infection.

·         Blood and lymphatic system disorders

- Uncommon: thrombocytopenia, leukopenia.

- Rare: pancytopenia, neutropenia, agranulocytosis.

·         Immune system disorders

- Rare: drug reaction with eosinophilia and systemic symptoms (DRESS), hypersensitivity (including angioedema and anaphylaxis).

·         Metabolism and nutrition disorders

- Common: anorexia.

- Uncommon: weight decreased, weight increase.

- Rare: hyponatraemia

·         Psychiatric disorders

- Common: depression, hostility/ aggression, anxiety, insomnia, nervousness/ irritability.

- Uncommon: suicide attempt, suicidal ideation, psychotic disorder, abnormal behaviour, hallucination, anger, confusional state, panic attack, affect lability/ mood swings, agitation.

- Rare: completed suicide, personality disorder, thinking abnormal.

·         Nervous system disorders

- Very common: somnolence, headache

- Common: convulsion, balance disorder, dizziness, lethargy, tremor.

- Uncommon: amnesia, memory impairment, coordination abnormal/ ataxia, paraesthesia, disturbance in attention.

- Rare: choreoathetosis, dyskinesia, hyperkinesia, gait disturbance.

·         Eye disorders

- Uncommon: diplopia, vision blurred.

·         Ear and labyrinth disorders

- Common: vertigo.

·         Respiratory, thoracic and mediastinal disorders

- Common: cough.

·         Gastrointestinal disorders

- Common: abdominal pain, diarrhoea, dyspepsia, vomiting, nausea.

- Rare: pancreatitis.

·         Hepatobiliary disorders

- Uncommon: liver function test abnormal.

- Rare: hepatic failure, hepatitis.

·         Renal and urinary disorders

- Rare: acute kidney injury.

·         Skin and subcutaneous tissue disorders

- Common: rash.

- Uncommon: alopecia, eczema, pruritus.                

- Rare: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme.

·         Musculoskeletal and connective tissue disorders

- Uncommon: muscular weakness, myalgia.

- Rare: rhabdomyolysis and blood creatine phosphokinase increased*.

·         General disorders and administration site conditions

- Common: asthenia/fatigue.

·         Injury, poisoning and procedural complications

- Uncommon: injury.

* Prevalence is significantly higher in Japanese patients when compared to non-Japanese patients.

Cases of encephalopathy have been rarely observed after levetiracetam administration. These undesirable effects generally occurred at the beginning of the treatment (few days to a few months) and were reversible after treatment discontinuation.

Description of selected adverse reactions

The risk of anorexia is higher when levetiracetamis coadministered with topiramate.

In several cases of alopecia, recovery was observed when levetiracetam was discontinued.

Bone marrow suppression was identified in some of the cases of pancytopenia.

Paediatric population

In patients aged 1 month to less than 4 years, a total of 190 patients have been treated with levetiracetam in placebo controlled and open label extension studies. Sixty of these patients were treated with levetiracetam in placebo-controlled studies. In patients aged 4-16 years, a total of 645 patients have been treated with levetiracetam in placebo-controlled and open label extension studies. 233 of these patients were treated with levetiracetam in placebo-controlled studies. In both these paediatric age ranges, these data are supplemented with the post-marketing experience of the use of levetiracetam.

In addition, 101 infants aged less than 12 months have been exposed in a post authorization safety study. No new safety concerns for levetiracetam were identified for infants less than 12 months of age with epilepsy.

The adverse event profile of levetiracetam is generally similar across age groups and across the approved epilepsy indications. Safety results in paediatric patients in placebo-controlled clinical studies were consistent with the safety profile of levetiracetam in adults except for behavioural and psychiatric adverse reactions which were more common 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%), affect lability (common, 1.7%), aggression (common, 8.2%), abnormal behaviour (common, 5.6%), and lethargy (common, 3.9%) were reported more frequently than in other age ranges or in the overall safety profile. In infants and children aged 1 month to less than 4 years, irritability (very common, 11.7%) and coordination abnormal (common, 3.3%) were reported more frequently than in other age groups or in the overall safety profile.

A double-blind, placebo-controlled paediatric safety study with a non-inferiority design has assessed the cognitive and neuropsychological effects of levetiracetam in children 4 to 16 years of age with partial onset seizures. It was concluded that levetiracetam was not different (non inferior) from placebo with regard to the change from baseline of the Leiter-R Attention and Memory, Memory Screen Composite score in the per-protocol population. Results related to behavioural and emotional functioning indicated a worsening in levetiracetam treated patients on aggressive behaviour as measured in a standardised and systematic way using a validated instrument (CBCL – Achenbach Child Behavior Checklist). However subjects, who took levetiracetam in the long term open label follow-up study, did not experience a worsening, on average, in their behavioural and emotional functioning; in particular measures of aggressive behaviour were not worse than baseline.

 

To report any side effect(s):

• Saudi Arabia:

The National Pharmacovigilance Center (NPC):

SFDA Call Center: 19999

E-mail: npc.drug@sfda.gov.sa

Website: https://ade.sfda.gov.sa

• Other GCC States:

Please contact the relevant competent authority.

 


Symptoms and signs

Somnolence, agitation, aggression, depressed level of consciousness, respiratory depression and coma were observed with levetiracetam overdoses.

Treatment

There is no specific antidote for levetiracetam. Treatment of an overdose will be symptomatic and may include haemodialysis. The dialyser extraction efficiency is 60 % for levetiracetam and 74 % for the primary metabolite.

Further management should be as clinically indicated or as recommended by the national poisons centre, where available.


Pharmacotherapeutic group: Antiepileptics; Other Antiepileptics

ATC Code: N03AX14

Mechanism of Action

The active substance, levetiracetam, is a pyrrolidone derivative (S-enantiomer of α-ethyl-2-oxo-1-pyrrolidine acetamide), chemically unrelated to existing antiepileptic active substances.

The mechanism of action of levetiracetam still remains to be fully elucidated. In vitro and in vivo experiments suggest that levetiracetam does not alter basic cell characteristics and normal neurotransmission.

In vitro studies show that levetiracetam affects intraneuronal Ca2+ levels by partial inhibition of N-type Ca2+ currents and by reducing the release of Ca2+ from intraneuronal stores. In addition it partially reverses the reductions in GABA- and glycine-gated currents induced by zinc and β-carbolines. Furthermore, levetiracetam has been shown in in vitro studies to bind to a specific site in rodent brain tissue. This binding site is the synaptic vesicle protein 2A, believed to be involved in vesicle fusion and neurotransmitter exocytosis. Levetiracetam and related analogs show a rank order of affinity for binding to the synaptic vesicle protein 2A which correlates with the potency of their anti-seizure protection in the mouse audiogenic model of epilepsy. This finding suggests that the interaction between levetiracetam and the synaptic vesicle protein 2A seems to contribute to the antiepileptic mechanism of action of the medicinal product.

Pharmacodynamic effects

Levetiracetam induces seizure protection in a broad range of animal models of partial and primary generalised seizures without having a pro-convulsant effect. The primary metabolite is inactive.

In man, an activity in both partial and generalised epilepsy conditions (epileptiform discharge/ photoparoxysmal response) has confirmed the broad spectrum pharmacological profile of levetiracetam.


Levetiracetam is a highly soluble and permeable compound. The pharmacokinetic profile is linear with low intra- and inter-subject variability. There is no modification of the clearance after repeated administration. There is no evidence for any relevant gender, race or circadian variability. The pharmacokinetic profile is comparable in healthy volunteers and in patients with epilepsy.

Due to its complete and linear absorption, plasma levels can be predicted from the oral dose of levetiracetam expressed as mg/kg bodyweight. Therefore, there is no need for plasma level monitoring of levetiracetam.

A significant correlation between saliva and plasma concentrations has been shown in adults and children (ratio of saliva/plasma concentrations ranged from 1 to 1.7 for oral tablet formulation and after 4 hours post-dose for oral solution formulation).

Adults and adolescents

Absorption

Levetiracetam is rapidly absorbed after oral administration. Oral absolute bioavailability is close to 100 %.

Peak plasma concentrations (Cmax) are achieved at 1.3 hours after dosing. Steady-state is achieved after two days of a twice daily administration schedule.

Peak concentrations (Cmax) are typically 31 and 43 μg/ml following a single 1,000 mg dose and repeated 1,000 mg twice daily dose, respectively.

The extent of absorption is dose-independent and is not altered by food.

Distribution

No tissue distribution data are available in humans.

Neither levetiracetam nor its primary metabolite are significantly bound to plasma proteins (< 10 %).

The volume of distribution of levetiracetam is approximately 0.5 to 0.7 l/kg, a value close to the total body water volume.

Biotransformation

Levetiracetam is not extensively metabolised in humans. The major metabolic pathway (24 % of the dose) is an enzymatic hydrolysis of the acetamide group. Production of the primary metabolite, ucb L057, is not supported by liver cytochrome P450 isoforms. Hydrolysis of the acetamide group was measurable in a large number of tissues including blood cells. The metabolite ucb L057 is pharmacologically inactive.

Two minor metabolites were also identified. One was obtained by hydroxylation of the pyrrolidone ring (1.6 % of the dose) and the other one by opening of the pyrrolidone ring (0.9 % of the dose).

Other unidentified components accounted only for 0.6 % of the dose.

No enantiomeric interconversion was evidenced in vivofor either levetiracetam or its primary metabolite.

In vitro, levetiracetam and its primary metabolite have been shown not to inhibit the major human liver cytochrome P450 isoforms (CYP3A4, 2A6, 2C9, 2C19, 2D6, 2E1 and 1A2), glucuronyl transferase (UGT1A1 and UGT1A6) and epoxide hydroxylase activities. In addition, levetiracetam does not affect the in vitro glucuronidation of valproic acid.

In human hepatocytes in culture, levetiracetam had little or no effect on CYP1A2, SULT1E1 or UGT1A1. Levetiracetam caused mild induction of CYP2B6 and CYP3A4. The in vitro data and in vivo interaction data on oral contraceptives, digoxin and warfarin indicate that no significant enzyme induction is expected in vivo. Therefore, the interaction of levetiracetam with other substances, or vice versa, is unlikely.

Elimination

The plasma half-life in adults was 7±1 hours and did not vary either with dose, route of administration or repeated administration. The mean total body clearance was 0.96 ml/min/kg.

The major route of excretion was via urine, accounting for a mean 95 % of the dose (approximately 93 % of the dose was excreted within 48 hours). Excretion via faeces accounted for only 0.3 % of the dose.

The cumulative urinary excretion of levetiracetam and its primary metabolite accounted for 66 % and 24 % of the dose, respectively during the first 48 hours.

The renal clearance of levetiracetam and ucb L057 is 0.6 and 4.2 ml/min/kg respectively indicating that levetiracetam is excreted by glomerular filtration with subsequent tubular reabsorption and that the primary metabolite is also excreted by active tubular secretion

in addition to glomerular filtration. Levetiracetam elimination is correlated to creatinine clearance.

Elderly

In the elderly, the half-life is increased by about 40 % (10 to 11 hours). This is related to the decrease in renal function in this population (see section 4.2).

Renal impairment

The apparent body clearance of both levetiracetam and of its primary metabolite is correlated to the creatinine clearance. It is therefore recommended to adjust the maintenance daily dose of levetiracetam, based on creatinine clearance in patients with moderate and severe renal impairment (see section 4.2).

In anuric end-stage renal disease adult subjects the half-life was approximately 25 and 3.1 hours during interdialytic and intradialytic periods, respectively.

The fractional removal of levetiracetam was 51 % during a typical 4-hour dialysis session.

Hepatic impairment

In subjects with mild and moderate hepatic impairment, there was no relevant modification of the clearance of levetiracetam. In most subjects with severe hepatic impairment, the clearance of levetiracetam was reduced by more than 50 % due to a concomitant renal impairment (see section 4.2).

Paediatric population

Children (4 to 12 years)

Following single oral dose administration (20 mg/kg) to epileptic children (6 to 12 years), the half-life of levetiracetam was 6.0 hours. The apparent body weight adjusted clearance was approximately 30 % higher than in epileptic adults.

Following repeated oral dose administration (20 to 60 mg/kg/day) to epileptic children (4 to 12 years), levetiracetam was rapidly absorbed. Peak plasma concentration was observed 0.5 to 1.0 hour after dosing. Linear and dose proportional increases were observed for peak plasma concentration and area under the curve. The elimination half-life was approximately 5 hours. The apparent body clearance was 1.1 ml/min/kg.

Infants and children (1 month to 4 years)

Following single dose administration (20 mg/kg) of a 100 mg/ml oral solution to epileptic children (1 month to 4 years), levetiracetam was rapidly absorbed and peak plasma concentrations were observed approximately 1 hour after dosing. The pharmacokinetic results indicated that half-life was shorter (5.3 h) than for adults (7.2 h) and apparent clearance was faster (1.5 ml/min/kg) than for adults (0.96 ml/min/kg).

In the population pharmacokinetic analysis conducted in patients from 1 month to 16 years of age, body weight was significantly correlated to apparent clearance (clearance increased with an increase in body weight) and apparent volume of distribution. Age also had an influence on both parameters. This effect was pronounced for the younger infants, and subsided as age increased, to become negligible around 4 years of age.

In both population pharmacokinetic analyses, there was about a 20 % increase of apparent clearance of levetiracetam when it was co-administered with an enzyme-inducing antiepileptic medicinal product.

 


Not relevant for this product.

Non-clinical information

Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, genotoxicity and carcinogenicity.

Adverse effects not observed in clinical studies but seen in the rat and to a lesser extent in the mouse at exposure levels similar to human exposure levels and with possible relevance for clinical use were liver changes, indicating an adaptive response such as increased weight and centrilobular hypertrophy, fatty infiltration and increased liver enzymes in plasma.

No adverse effects on male or female fertility or reproduction performance were observed in rats at doses up to 1800 mg/kg/day (x 6 the MRHD on a mg/m2 or exposure basis) in parents and F1 generation.

Two embryo-foetal development (EFD) studies were performed in rats at 400, 1200 and 3600 mg/kg/day. At 3600 mg/kg/day, in only one of the 2 EFD studies, there was a slight decrease in foetal weight associated with a marginal increase in skeletal variations/minor anomalies. There was no effect on embryomortality and no increased incidence of malformations. The NOAEL (No Observed Adverse Effect Level) was 3600 mg/kg/day for pregnant female rats (x 12 the MRHD on a mg/m2 basis) and 1200 mg/kg/day for foetuses.

Four embryo-foetal development studies were performed in rabbits covering doses of 200, 600, 800, 1200 and 1800 mg/kg/day. The dose level of 1800 mg/kg/day induced a marked maternal toxicity and a decrease in foetal weight associated with increased incidence of foetuses with cardiovascular/skeletal anomalies. The NOAEL was <200 mg/kg/day for the dams and 200 mg/kg/day for the foetuses (equal to the MRHD on a mg/m2 basis).

A peri- and post-natal development study was performed in rats with levetiracetam doses of 70, 350 and 1800 mg/kg/day. The NOAEL was ≥ 1800 mg/kg/day for the F0 females, and for the survival, growth and development of the F1 offspring up to weaning (x 6 the MRHD on a mg/m2 basis).

Neonatal and juvenile animal studies in rats and dogs demonstrated that there were no adverse effects seen in any of the standard developmental or maturation endpoints at doses up to 1800 mg/kg/day (x 6–17 the MRHD on a mg/m2 basis).

Environmental Risk Assessment (ERA)

The use of levetiracetam in accordance with the product information is not likely to result in an unacceptable environmental impact (see Section Incompatibilities and Use and Handling).

 


The other ingredients are dibasic calcium phosphate, crospovidone, hydroxypropyl cellulose, microcrystalline cellulose, Opadry II white, yellow iron oxide, purified water.


None.


24 months.

Store below 30°C.

As with all medicines, keep this product out of the reach of children.


Vetam® 500 mg: Yellow oval biconvex film coated tablet engraved with C33 on one side and plain on the other side, intended for oral use.

Pack size: 30 Film Coated Tablets.

 

Vetam®1000 mg: White oval biconvex film coated tablet engraved with C35 on one face, intended for oral use.

Pack size: 30 Film Coated Tablets.


No special requirements.


Med City Pharma – KSA. Tel: 00966920003288 Fax: 00966126358138 Mobile: 00966555786968 P.O .Box: 42512 - Jeddah 21551 E-mail: MD.admin@axantia.com

03/2022
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