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Keppra vs Depakote
Introduction
For patients with epilepsy or other types of seizure disorders, certain drugs that alter the balance of electrical activity in the brain can help in managing seizures and reducing their frequency. Keppra and Depakote are two such drugs that are commonly prescribed for these conditions. Both medications work by affecting different aspects of neuronal signaling, but both have effects on reducing seizure frequency and intensity in patients with epilepsy.
Keppra (levetiracetam) is unique among antiepileptic drugs as it does not work by interacting with a specific receptor or ion channel; instead, it binds to synaptic vesicle protein 2A (SV2A), which may influence neurotransmitter release. On the other hand, Depakote (valproic acid) functions through multiple mechanisms including increasing GABA levels - an inhibitory neurotransmitter -, blocking voltage-gated sodium channels and T-type calcium channels. This multi-modal action helps stabilize hyper-excitable neurons thus curtailing seizure activity.
Keppra vs Depakote Side By Side
| Attribute | Keppra | Depakote |
|---|---|---|
| Brand Name | Keppra | Depakote |
| Contraindications | Should not be taken if you are taking or have recently been on monoamine oxidase inhibitors (MAOIs) without discussing it with your physician first. | Should not be taken if you are taking or have recently been on monoamine oxidase inhibitors (MAOIs) without discussing it with your physician first. |
| Cost | For brand name: around $880 for 60 tablets of 500 mg. For generic (Levetiracetam): ranges from approximately $0.80 to under $0.20 per day depending on quantity. | For brand name: over $900 for 60 tablets of 500mg. For generic (Divalproex Sodium): starts from as little as about $.50 per tablet. |
| Generic Name | Levetiracetam | Divalproex Sodium |
| Most Serious Side Effect | Thoughts of self-harm or suicide, severe skin reactions, vision problems, symptoms related to low sodium levels, nervous system reaction signs. | Liver problems, pancreatitis, changes in mood or behavior, severe allergic reactions. |
| Severe Drug Interactions | MAOIs | MAOIs |
| Typical Dose | For adults and adolescents 16 years of age and older: 1000-3000 mg/day divided into two doses. | Initiated at a dosage of 10-15 mg/kg/day, can be increased by 5–10 mg/kg/week to achieve optimal clinical response, typically within the range of 1000 to 2000mg/day. |
What is Keppra?
Levetiracetam (the generic name for Keppra) was a significant advancement in the class of drugs known as antiepileptics, compared to its predecessor, Divalproex Sodium (Depakote). Levetiracetam was first approved by the FDA in 1999 and is used primarily for treating seizures associated with epilepsy. Similar to how Prozac increases levels of serotonin, Keppra works by affecting the transmission of nerve signals in the brain, thus reducing seizure activity. It's prescribed for different forms of epilepsy and has been shown to be particularly effective against partial onset seizures. While Depakote also impacts neural signalling and can treat similar conditions, it carries more potential side effects due to its broader range of influence on different neurotransmitters. Therefore, despite both being effective antiepileptic medications, Keppra is considered generally safer than Depakote due to less severe side effect profiles.
What conditions is Keppra approved to treat?
Keppra is approved by the FDA to manage various forms of seizures:
- Primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy
- Myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy
- Partial onset seizures in adults and children 1 month of age and older with epilepsy
How does Keppra help with these illnesses?
Keppra helps to manage epilepsy by stabilizing electrical activity in the brain. It does this by binding to synaptic vesicle protein 2A (SV2A), found in the space where nerve cells connect. This action is thought to interfere with the release of neurotransmitters, chemicals that nerves use to communicate with each other. Uncontrolled firing of these neurons can lead to seizures, a common symptom of epilepsy. By preventing excessive neuronal activity, Keppra can limit the negative effects of epilepsy and help patients manage their condition and stabilize their brain function.
Depakote works similarly yet differently; it increases levels of gamma-aminobutyric acid (GABA) in the brain, another important neurotransmitter which inhibits or slows down nerve impulses. Depakote also affects voltage-dependent sodium channels which further contributes its antiepileptic effect.
Choosing between these two medications would often depend on individual patient factors like specific seizure type(s), co-existing medical conditions, potential for drug interactions and personal tolerance for possible side-effects among others.
What is Depakote?
Depakote, or divalproex sodium, is a medication that works by restoring the balance of certain natural substances (neurotransmitters) in the brain. It was first approved by the FDA in 1983. As Depakote is not an antiepileptic drug (AED), it does not inhibit voltage-gated sodium channels like Keppra does. Its lack of action on these channels means that its side-effect profile is also different to that of AEDs such as Keppra, particularly in that it can cause sedation and weight gain but is less likely to cause behavioral changes (a common side effect of AEDs like Keppra). The effects on neurotransmitter balance can be beneficial for treatment of seizures and bipolar disorder, especially in patients who do not respond well to the "typical" AED drugs such as Keppra.
What conditions is Depakote approved to treat?
Depakote has been approved by the FDA for treatment of several conditions, including:
- Epilepsy (as it works to prevent seizures)
- Manic episodes associated with bipolar disorder
- Prophylaxis of migraine headaches.
It's important to note that while both Depakote and Keppra are used in managing epilepsy, they have different mechanisms of action and side effects profiles. Always consult your healthcare provider for advice tailored to your specific circumstances.
How does Depakote help with these illnesses?
Depakote, also known as divalproex sodium or valproate, is a medication primarily used to treat certain types of seizures and bipolar disorder. It plays its role by affecting the concentration of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that nerves use to communicate with one another, and it's believed that an excess activity of nerves may lead to seizures and prevent the normalization of mood. Depakote works by increasing the levels of GABA available in the brain, thereby controlling seizures and stabilizing moods. Its action on calcium channels may also play roles in its effectiveness as an anticonvulsant drug. Since it does not significantly affect glutamate levels like Keppra, it is sometimes prescribed when a patient does not respond well to other seizure or mood-stabilizing medications such as Keppra or can be combined with these drugs for enhanced efficacy.
How effective are both Keppra and Depakote?
Both levetiracetam (Keppra) and divalproex sodium (Depakote) have established histories of success in controlling seizures in patients with epilepsy, and they were initially approved by the FDA within a decade of each other. Because they act on different pathways involved in seizure activity, they may be prescribed under different circumstances. The effectiveness of Keppra versus Depakote was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy in managing epileptic seizures as well as comparable safety profiles.
A 2007 Cochrane review demonstrated that levetiracetam is effective at reducing seizure frequency amongst patients starting from the first week of treatment, its side effect profile is generally favorable compared to many other antiepileptics, and it's well-tolerated even among elderly populations. The study also reported that Levetiracetam has become one of the most widely prescribed antiepileptic drugs worldwide because it doesn't require blood monitoring like some older medications do.
On the other hand, a 2015 meta-analysis indicated that Depakote seems to be more effective than placebo for certain types of epilepsy like generalized onset seizures but carries an increased risk for weight gain and metabolic complications compared to others. Despite these potential drawbacks, Depakote can still be considered if initial treatments fail or are not tolerated due to its broad-spectrum efficacy against various types of seizures. It’s often used when treating people who experience multiple forms of seizures who need coverage across several fronts.
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At what dose is Keppra typically prescribed?
Oral dosages of Keppra for adults and adolescents 16 years of age and older range from 1000-3000 mg/day divided into two doses. However, studies have indicated that a starting dose of 1000 mg/day is sufficient for treating epilepsy in most people. Meanwhile, the dosage for Depakote starts at 250 mg twice a day for adults with acute manic or mixed episodes associated with bipolar disorder. This can be increased as necessary, usually reaching about 1000 - 2000 mg daily in divided doses. For both medications, the dosage can be adjusted based on individual response and tolerability while staying within safe limits as determined by your health care provider.
At what dose is Depakote typically prescribed?
Depakote treatment is usually initiated at a dosage of 10-15 mg/kg/day. The dose can then be increased by 5–10 mg/kg/week to achieve optimal clinical response, typically within the range of total daily doses from 1000 to 2000mg, divided into two doses and spaced approximately 12 hours apart. However, doses up to a maximum of 60 mg/kg/day could be considered if there is no sufficient response after several weeks of therapy at lower dosages. As always, any changes in dosage should only be made under the guidance and supervision of your healthcare provider.
What are the most common side effects for Keppra?
Common side effects associated with the use of Keppra and Depakote include:
- Drowsiness or sleepiness
- Weakness or fatigue
- Dizziness
- Coordination problems
- Infections
- Nausea, vomiting, stomach pain
- Tremor (unintentional trembling or shaking)
-Anxiety and mood swings
-Diarrhea
-Rash
-Loss of appetite
-Hair loss (more common in Depakote)
-Increased weight gain (especially seen in Depakote) -Pancreatitis and liver damage can also occur particularly with the long-term use of Depakote.
It is important to note that not everyone experiences these side effects, but if they do occur it's crucial to consult your healthcare provider immediately.
Are there any potential serious side effects for Keppra?
In rare instances, potentially severe side effects can occur when taking Keppra. These might include:
- Thoughts of self-harm or suicide
- Signs of an allergic reaction: difficulty breathing, hives, swelling in your face or throat
- Severe skin reactions: a rash that blisters and peels, fever and sore throat, burning eyes
- Vision problems such as blurred vision or seeing halos around lights
- Symptoms related to low sodium levels like headache, slurred speech, vomiting and feeling unsteady due to severe weakness or lack of coordination
- Nervous system reaction signs including rigid muscles (stiffness), high fever, sweating excessively leading to confusion; fast heartbeats causing tremors or feeling light-headed enough to pass out.
If any symptoms arise which resemble serotonin syndrome - agitation accompanied by hallucinations; high temperature resulting in excessive sweatiness; muscle rigidity inducing shivering along with a rapid pulse rate; loss of body balance linked with twitching movements - contact emergency medical services immediately. There may also be gastrointestinal disruptions such as nausea followed by vomiting episodes and diarrhoea.
What are the most common side effects for Depakote?
Depakote, another medication used in managing epilepsy and bipolar disorder, can have a range of side effects. These may include:
- Nausea, vomiting, stomach pain or cramps
- Constipation or diarrhea
- Dry mouth
- Changes in appetite leading to weight changes (gain or loss)
- Dizziness or drowsiness
- Hair loss
- Blurred vision
- Tremors
- Trouble sleeping (insomnia)
- Unusual weakness or tiredness
In some cases, Depakote may also cause more serious side effects such as rapid heartbeat, mood swings including confusion and agitation, ringing in ears and skin rash. It's important to note that these are potential side effects; not everyone who takes Depakote will experience them.
Are there any potential serious side effects for Depakote?
While Depakote is widely used and often effective, it's important to be aware of potential serious side effects. These may include:
- Signs of a severe allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat.
- Liver problems: nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine or clay-colored stools and jaundice (yellowing of the skin or eyes).
- Pancreatitis: severe pain in your upper stomach spreading to your back accompanied by nausea and vomiting.
- Changes in mood or behavior: new or worsening depression symptoms like suicidal thoughts or extreme changes in behavior such as aggression and agitation.
- Severe drowsiness
- Easy bruising
- Unusual bleeding such as nosebleeds.
If any of these signs are observed while using Depakote you should seek immediate medical attention.
Contraindications for Keppra and Depakote?
Both Keppra and Depakote, like other anti-seizure medications, can potentially exacerbate mood disorders in certain individuals. If you notice an increase in feelings of depression, suicidal thoughts or behavior while on these medications, please seek immediate medical attention.
Neither Keppra nor Depakote should be taken if you are taking or have recently been on monoamine oxidase inhibitors (MAOIs) without discussing it with your physician first. MAOIs need around 5 weeks to completely clear out from your system to prevent harmful interactions with both Keppra and Depakote. It is critical that you always disclose any medication usage to your healthcare provider to ensure safe treatment planning.
How much do Keppra and Depakote cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Keppra (500 mg) averages around $880, which works out to about $14-$28/day depending on your dosage.
- The price for 60 tablets of Depakote (500mg) is typically over $900, working out to approximately $15-$30 per day.
Thus, if you are in the higher dosage range for Keppra (i.e., 2000 mg/day or higher), then brand-name Depakote could be less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions Levetiracetam (Keppra) and Divalproex sodium (Depakote), costs are significantly lower:
- Levetiracetam comes in packs from 30 up to hundreds with approximate daily costs ranging anywhere from approximately $0.80 to as low as under $0.20 if buying larger quantities upfront.
-Divalproex Sodium pack prices vary widely but can start from as little as about $.50 per tablet and go upwards depending upon quantity and strength purchased.
As always it's essential to remember that while pricing is important so too is efficacy and potential side effects; both medications are used primarily to manage epilepsy but have different mechanisms by which they work - this may affect their appropriateness depending on an individual’s specific condition.
Popularity of Keppra and Depakote
Levetiracetam, under the brand name Keppra and its generic forms, was prescribed to about 3.2 million people in the US in 2020. Levetiracetam accounts for approximately 12% of antiepileptic drug prescriptions in the United States. As a newer generation antiepileptic drug with a unique mechanism of action, levetiracetam has seen an increase in use since its introduction.
On the other hand, valproic acid (Depakote) accounted for roughly 1.7 million prescriptions during that same year. Valproic acid represents around 8% of all antiepileptic drug prescriptions within America. While it's been available much longer than levetiracetam and is utilized across more diverse indications including bipolar disorder and migraine prevention, its prevalence has held relatively steady over recent years.
Conclusion
Both Keppra (levetiracetam) and Depakote (divalproex sodium or valproate semisodium) have a long-standing record of usage in managing epilepsy, and are backed by numerous clinical studies indicating they are more effective than placebo treatments. In some cases, the drugs may be combined to provide better seizure control, but this is subject to careful consideration by a physician due to possible interactions. Due to their different mechanisms of action, with Keppra acting on synaptic vesicle protein SV2A and Depakote increasing GABA levels in the brain, they tend to be prescribed under different circumstances.
Keppra is often considered as first-line treatment for partial onset seizures and primary generalized tonic-clonic seizures while Depakote has been used as an initial treatment for complex partial seizures or absence seizures.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out-of-pocket. Both Keppra and Depakote may require an adjustment period meaning that effects might not be noticeable right away.
The side effect profile is similar between these two antiepileptic drugs; however, it's notable that weight gain can occur with depakote use whereas keppra does not typically cause this issue. For both medications though patients should monitor any changes particularly when starting therapy such as worsening mood or increased frequency of seizures.
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Refrences
- Stefan, H., & Fraunberger, B. (2005, July). Valproat Retard in der Epilepsietherapie. Fortschritte der Neurologie · Psychiatrie. Georg Thieme Verlag KG.http://doi.org/10.1055/s-2004-830299
- Safdieh, J., & Ulloa, C. (2009, September). Review of levetiracetam, with a focus on the extended release formulation, as adjuvant therapy in controlling partial-onset seizures. Neuropsychiatric Disease and Treatment. Informa UK Limited.http://doi.org/10.2147/ndt.s4844
- Kaminski, R. M., Matagne, A., Patsalos, P. N., & Klitgaard, H. (2009, March). Benefit of combination therapy in epilepsy: A review of the preclinical evidence with levetiracetam. Epilepsia. Wiley.http://doi.org/10.1111/j.1528-1167.2008.01713.x
- Shiah, I.-S., Yatham, L. N., & Baker, G. B. (2000, July). Divalproex sodium increases plasma GABA levels in healthy volunteers. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00004850-200015040-00005
- Shorvon, S. D., Löwenthal, A., Janz, D., Bielen, E., Loiseau, P., & for the European Levetiracetam Study Group. (2000, September). Multicenter Double‐Blind, Randomized, Placebo‐Controlled Trial of Levetiracetam as Add‐On Therapy in Patients with Refractory Partial Seizures. Epilepsia. Wiley.http://doi.org/10.1111/j.1528-1157.2000.tb00323.x
- ALSAADI, T. M., & THIEMAN, C. (2003, April). Levetiracetam monotherapy for newly diagnosed epilepsy patients. Seizure. Elsevier BV.http://doi.org/10.1016/s1059-1311(02)00274-1