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Keppra vs Vimpat
Introduction
For patients with epilepsy or other forms of seizure disorders, certain drugs that alter the electrical activity in the brain can be effective in controlling seizures and improving quality of life. Keppra and Vimpat are two such medications prescribed for managing these conditions. They each have a different mechanism of action but both help to stabilize neuronal hyperactivity which causes seizures. Keppra (levetiracetam) works by binding to synaptic vesicle protein SV2A, thought to result in the inhibition of presynaptic calcium channels reducing neurotransmitter release. On the other hand, Vimpat (lacosamide), is known as a functionalized amino acid that enhances slow sodium channel inactivation thereby stabilizing overactive firing neurons without affecting normal neuron signaling.
Keppra vs Vimpat Side By Side
| Attribute | Keppra | Vimpat |
|---|---|---|
| Brand Name | Keppra | Vimpat |
| Contraindications | Increased risk of suicidal thoughts or behavior, should not be taken with medications that interact negatively without consulting a doctor. | Increased risk of suicidal thoughts or behavior, should not be taken with medications that interact negatively without consulting a doctor. |
| Cost | From around $0.20 to $2.50 per day for the generic version. Brand-name around $900 for 60 tablets (500 mg). | Roughly between $9 and $18 daily for the generic version. Brand-name around $1,300 for 60 tablets (100 mg each). |
| Generic Name | Levetiracetam | Lacosamide |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, severe allergic reactions. | Allergic reaction or severe skin reaction, suicidal thoughts or behavior, irregular heart rate (arrhythmia). |
| Severe Drug Interactions | May interact negatively with certain types of antidepressants and sedatives. | May interact negatively with certain types of antidepressants and sedatives. |
| Typical Dose | For adults and adolescents aged 16 years and older: 1000-3000 mg/day, typically divided into two doses. | Usually initiated at a daily dosage of 50 mg twice a day, can be increased to 100–200 mg two times per day. Maximum recommended daily dose is 400mg. |
What is Keppra?
Levetiracetam (the generic name for Keppra) is an antiepileptic drug that was first approved by the FDA in 1999. It is used to treat epilepsy and works by decreasing abnormal excitement in the brain. Levetiracetam does not cure epilepsy and only works to control seizures as long as the medication is taken.
On the other hand, Lacosamide (Vimpat's generic name) also belongs to a class of drugs known as antiepileptics and it received its approval from FDA later in 2008. Vimpat impacts sodium channels in neurons, helping balance neuronal activity thereby reducing seizure occurrences.
Both medications are suitable for treating partial-onset seizures but their mechanisms of action are different resulting into varied side effects among patients. While both can cause dizziness or tiredness, Vimpat may have additional side effects like double vision and difficulty with coordination which doesn’t usually occur with Keppra.
What conditions is Keppra approved to treat?
Keppra and Vimpat are both approved for the treatment of certain types of seizure disorders:
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Keppra (levetiracetam) is indicated for use in the treatment of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures, both as monotherapy and adjunctive therapy.
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Vimpat (lacosamide), on the other hand, is used to manage partial-onset seizures in adults with epilepsy. It can be used either as an add-on therapy or alone in patients who switch from other antiepileptic drugs.
How does Keppra help with these illnesses?
Keppra aids in managing epilepsy by stabilizing electrical activity in the brain. It does this by binding to synaptic vesicle protein SV2A, which is believed to impede nerve conduction across synapses. Epileptic seizures are caused by abnormal patterns of electrical activity in the brain that can lead to a variety of symptoms, including uncontrolled movements, altered awareness or consciousness, and other behavioral changes. By reducing the excitability of neurons in the brain with Keppra, patients can manage their condition and significantly reduce seizure frequency.
On the other hand, Vimpat also manages epilepsy but it works differently from Keppra. Vimpat works by enhancing slow inactivation of sodium channels which reduces neuron excitability thus preventing epileptic seizures. This way both drugs help mitigate different types of epileptic seizures helping patients control their condition effectively.
What is Vimpat?
Vimpat is a brand name for lacosamide, an antiepileptic drug that was first approved by the FDA in 2008. Its unique mechanism of action involves selectively enhancing slow sodium channel activity to stabilize hyperexcitable neuronal membranes and inhibit repetitive firing of neurons. This makes it different from other antiepileptic drugs such as Keppra (levetiracetam), which modulates synaptic neurotransmitter release through its effect on vesicle protein SV2A.
As Vimpat doesn't interact with common neurotransmitters like GABA or glutamate, its side-effect profile differs from other epileptics. For instance, it doesn’t typically cause sedation or cognitive impairment - common side effects linked to drugs like Keppra. The effectiveness of Vimpat in managing partial-onset seizures can be especially beneficial for patients who haven't had satisfactory control with other epilepsy medications including Keppra.
What conditions is Vimpat approved to treat?
Vimpat is an antiepileptic drug approved by the FDA for the treatment of partial-onset seizures in adults and children 4 years of age and older. It can be used as a standalone medication or in combination with other antiepileptics. Vimpat has also been shown to reduce seizure frequency when added to existing epilepsy treatments, providing another option for patients whose seizures are not well controlled on their current medications.
How does Vimpat help with these illnesses?
Vimpat, like Keppra, is a type of antiepileptic medication used primarily in the management and treatment of seizures. The specific mechanism behind Vimpat's effect is not entirely understood, but it's believed to work by modifying sodium channels in neurons while also interacting with synaptic vesicle protein 2A (SV2A) in the brain. This interaction helps reduce abnormal electrical activity and control seizures. Its action on SV2A may also play roles in its effectiveness as an anticonvulsant drug. Since it has unique properties compared to other seizure medications such as Keppra, Vimpat can be prescribed when a patient doesn't respond well to typical anti-seizure drugs or it may be combined with other epilepsy medications for enhanced efficacy.
How effective are both Keppra and Vimpat?
Levetiracetam (Keppra) and lacosamide (Vimpat) are both antiepileptic drugs with strong records in the management of partial-onset seizures. Both were approved by the FDA within a decade of each other, Keppra in 1999 and Vimpat in 2008. They work through distinct modes of action: levetiracetam acts on synaptic vesicle proteins impacting neurotransmitter release, while lacosamide selectively enhances slow-inactivation of voltage-gated sodium channels.
Their effectiveness was directly compared in a double-blind clinical trial conducted in 2017; both exhibited similar efficacy for seizure reduction with comparable safety profiles. No significant differences were found between patients receiving either drug concerning seizure frequency reduction, responder rate, or adverse events incidence.
A review published in Epilepsy Research and Treatment highlighted that levetiracetam has broad-spectrum activity against various types of seizures from the first week of treatment and is usually well-tolerated across different age groups. The study also pointed out that it's one of the most commonly prescribed antiepileptic medications worldwide due to its favorable pharmacokinetics profile which includes no significant interactions with other drugs.
On the other hand, a meta-analysis performed by Therapeutic Advances Neurological Disorders suggested that lacosamide appears as effective as placebo for reducing seizure frequency but less robust data exists confirming its efficacy as stand-alone therapy compared to levetiracetam. Nevertheless, due to its unique mechanism among antiepileptics affecting slow-inactivation sodium channels without impact on fast-inactivation ones may make it an optimal choice for individuals who do not respond well to traditional treatments or have particular needs such as renal insufficiency or potential drug-drug interaction concerns.
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At what dose is Keppra typically prescribed?
Oral dosages of Keppra for adults and adolescents aged 16 years and older range from 1000-3000 mg/day, typically divided into two doses. However, some studies suggest that a starting dose of 1000mg/day is sufficient for managing epilepsy in most patients. Children's dosage varies based on body weight so it must be determined by their healthcare provider. If necessary, the dosage can be increased every two weeks. The maximum daily dosage should not exceed 3000mg for adults and adolescents.
On the other hand, Vimpat dosing starts at 50 mg twice daily (or 100 mg once daily) for adults and can be increased after a week to achieve desired therapeutic effect up to a maximum total dose of 400 mg per day. For pediatric patients aged between four to less than seventeen years old, the starting dosage is calculated based on body weight but should not exceed an initial dose of 200mg per day.
At what dose is Vimpat typically prescribed?
Vimpat treatment is usually initiated at a daily dosage of 50 mg twice a day, which can then be increased to 100–200 mg two times per day, depending on patient response and tolerance. The dose increments should not exceed more than an additional 100mg twice daily in any one-week period. It's important that the doses are evenly spaced throughout the day with no more than 12 hours between each dose. The maximum recommended daily dose is 400mg; however, if adequate seizure control is not achieved at this level or side effects become problematic, doctors may consider further adjustments after careful evaluation. This medication should always be taken under medical supervision due to potential interactions and adverse reactions.
What are the most common side effects for Keppra?
Common side effects of Keppra can include:
- Sleepiness/drowsiness
- Weakness or lack of energy
- Dizziness
- Nervousness or anxiety
- Unintentional trembling or shaking
- Loss of appetite, nausea, diarrhea,
- Infections (flu-like symptoms)
- Mood swings and behavioral changes
On the other hand, Vimpat may cause side effects such as:
- Headache
- Dizziness
- Double vision/blurred vision
- Nausea, vomiting
-Tiredness (general weakness and fatigue) -Increased risk for heart rhythm problems -Impaired coordination/balance problems
Always consult with your healthcare provider if you experience any adverse effects from either medication.
Are there any potential serious side effects for Keppra?
While both Keppra and Vimpat are used to manage seizures, they have different side effects profiles. Here are some potential adverse reactions you should be aware of when taking these medications:
- Increased thoughts about suicide or self-harm: This is a serious but rare side effect observed with the use of antiepileptic drugs including Keppra and Vimpat. It's essential to monitor mood changes and report any signs of depression or suicidal thoughts to your healthcare provider.
- Signs of allergic reaction: These can include hives, difficulty breathing, swelling in your face or throat - if you experience any of these symptoms while taking either drug, seek medical attention immediately
- Vision problems: While blurred vision or seeing halos around lights has been reported in patients taking Vimpat; this is less common with Keppra
- Heart rate changes: Both medications may cause heart palpitations (fast or pounding heartbeat), although it’s more commonly associated with Vimpat.
- Electrolyte imbalance - Low sodium levels could potentially occur leading to headache, confusion, slurred speech among other symptoms. This is more common with Vimpat than Keppra.
- Severe nervous system reaction: Symptoms such as rigid muscles, high fever sweating etc., though extremely rare could potentially occur due to an allergic response to either medication.
Remember that not everyone experiences these side effects and often they're temporary as your body adjusts to the new medication. However always consult your doctor if you’re concerned about potential risks associated with these epilepsy medications.
What are the most common side effects for Vimpat?
Those who take Vimpat might experience certain side effects:
- Dizziness and headache
- Double or blurred vision
- Sleep problems, including insomnia
- Nausea and vomiting, upset stomach
- Tiredness and lack of energy
- Unsteady balance or coordination difficulties
- Rash or itching skin
Additionally, more serious side effects such as a fast or irregular heartbeat should be reported to your healthcare provider immediately. It's important to remember that not everyone will experience these side effects, but if you do have any concerns about them, consult with your medical professional for advice.
Are there any potential serious side effects for Vimpat?
Vimpat, like other antiepileptic drugs, can cause certain side effects that require immediate medical attention. Here are some of the possible adverse reactions:
- Allergic reaction or severe skin reaction: rash, itching, hives, fever, swollen glands in your neck or face
- Suicidal thoughts or behavior: a sudden surge in depression symptoms and suicidal ideation is a potential risk with Vimpat use
- Seizures: despite being an anti-seizure medication itself, Vimpat may occasionally exacerbate seizures under certain circumstances
- Mood changes and confusion: unusual shifts in mood or behavior might be evident
- Visual disturbances: blurry vision or double vision are potential side effects
- Irregular heart rate (arrhythmia): though rare this could potentially occur with Vimpat.
Immediately consult your healthcare provider if you notice any of these symptoms when using Vimpat.
Contraindications for Keppra and Vimpat?
Both Keppra and Vimpat, like most antiepileptic drugs, may increase the risk of suicidal thoughts or behavior in some individuals. If you notice mood changes, worsening depression, or an increase in suicidal ideation, thoughts, or behaviors while taking either medication, please contact your healthcare provider immediately.
Neither Keppra nor Vimpat should be taken if you are using other medications that can interact negatively with them without consulting your doctor first. This includes certain types of antidepressants and sedatives among others. Always inform your physician about any over-the-counter (OTC) medicines or herbal supplements you might be consuming; these could lead to harmful drug interactions with both Keppra and Vimpat.
Furthermore, abruptly stopping treatment with either drug can cause a return of seizures; therefore any discontinuation should be under the direct supervision of a healthcare professional who will gradually reduce the dosage.
How much do Keppra and Vimpat cost?
In terms of brand-name versions:
- The price for 60 tablets of Keppra (500 mg) averages around $900, which works out to approximately $15–$30 per day, depending on your prescribed dosage.
- The cost of Vimpat is significantly higher. For example, a pack of 60 tablets (100 mg each) can run you about $1,300 or roughly $22–$43 per day.
Therefore, if you are in the higher dosage range for Keppra (i.e., 2000 mg/day or more), then brand-name Vimpat may be less expensive on a daily treatment basis. However, it's vital to remember that cost should not be the primary factor when deciding between these drugs; their effectiveness and side effect profiles also play crucial roles.
As for generic versions:
- Levetiracetam (generic form of Keppra) typically costs from around $0.20 to $2.50 per day based on dosages ranging from 250mg/day up to recommended maximums like 3000mg/day.
- Lacosamide (Vimpat's generic version), while cheaper than its branded counterpart at roughly between $9 and $18 daily based on typical doses from 200mg up to even potentially as high as 600mg/day - remains notably pricier than levetiracetam overall.
Please note that prices vary widely by location and pharmacy so always check multiple sources when comparing medication costs.
Popularity of Keppra and Vimpat
Levetiracetam, available as a generic drug and under the brand name Keppra, was prescribed to approximately 2.9 million people in the US in 2020. Levetiracetam accounted for about 15% of antiepileptic prescriptions in the US during this period. It's noteworthy that levetiracetam can be used across age groups, from infants to elderly patients, which may account for its widespread use.
Lacosamide, on the other hand, is marketed under various brand names including Vimpat and was prescribed to around 1 million individuals in the USA within that same year. Lacosamide makes up just over 5% of overall antiepileptic prescriptions within America. The prevalence of lacosamide has been steadily increasing since it gained approval by the FDA back in 2008.
Conclusion
Both Keppra (levetiracetam) and Vimpat (lacosamide) have proven their efficacy in managing seizures in patients with epilepsy, supported by extensive clinical research indicating that they are more effective than placebo treatments. Occasionally, these drugs may be used together if necessary, but this should only be done under meticulous supervision of a physician due to potential drug interactions. Their mechanisms of action differ significantly; Keppra alters synaptic vesicle protein SV2A whereas Vimpat slows the rate of sodium channel recovery.
Keppra is often considered as a first-line therapy for epilepsy treatment while Vimpat is usually prescribed when other therapies fail or aren't well-tolerated by the patient due to side effects or contraindications.
Both medications are available as generics which can lead to substantial cost savings especially for uninsured patients. Patients starting on either Keppra or Vimpat might need an adjustment period since benefits may not become apparent immediately.
The side effect profiles for both drugs are somewhat similar; both medicines generally being well tolerated but with each carrying its own unique set of potential adverse effects. For instance, behavioral issues like irritability and aggression are more common with Keppra while dizziness and headache appear more frequently with Vimpat usage. It's imperative that patients monitor their health status closely when initiating therapy and seek immediate medical help if new symptoms arise or existing ones worsen.
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Refrences
- 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
- 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
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- Harris, J. A., & Murphy, J. A. (2009, October 20). Lacosamide: An Adjunctive Agent for Partial-Onset Seizures and Potential Therapy for Neuropathic Pain. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.1m303
- Liu, A., Gu, Q., & Wang, M. (2020, August 19). Effects of levetiracetam and lacosamide on therapeutic efficacy and neural function in patients with epilepsy. Experimental and Therapeutic Medicine. Spandidos Publications.http://doi.org/10.3892/etm.2020.9126
- Toublanc, N., Sargentini-Maier, M. L., Lacroix, B., Jacqmin, P., & Stockis, A. (2008). Retrospective Population Pharmacokinetic Analysis of Levetiracetam in Children and??Adolescents with Epilepsy. Clinical Pharmacokinetics. Springer Science and Business Media LLC.http://doi.org/10.2165/00003088-200847050-00004
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