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Trileptal vs Keppra
Introduction
For patients diagnosed with epilepsy or other types of seizure disorders, certain drugs that alter the levels of neurotransmitters in the brain can help manage symptoms and prevent seizures. Trileptal (oxcarbazepine) and Keppra (levetiracetam) are two such medications commonly prescribed for these conditions. While both have proven efficacy in managing seizures, they work through different mechanisms within the nervous system. Trileptal works by decreasing nerve impulses that cause seizures, while Keppra operates on a broader range of neuronal channels and receptors to exert its anticonvulsant effects. It's important to note that while these medications can be highly effective, their suitability depends on various factors like patient's individual health profile and type of seizure disorder.
Trileptal vs Keppra Side By Side
| Attribute | Trileptal | Keppra |
|---|---|---|
| Brand Name | Trileptal | Keppra |
| Contraindications | Should not be taken with MAO inhibitors or stopped suddenly without consulting a doctor. | Should not be taken with MAO inhibitors or stopped suddenly without consulting a doctor. |
| Cost | Brand-name: Around $500 for 60 tablets of 300 mg. Generic: Around $1.50 - $2 per day for dosages between 600 and 2400 mg. | Brand-name: About $850 for 60 tablets of 500 mg. Generic: About $0.80 –$3 per day for dosages between 1000mg and 3000mg. |
| Generic Name | Oxcarbazepine | Levetiracetam |
| Most Serious Side Effect | Severe skin reactions, low sodium levels in the body, severe nervous system reaction. | Mood or behavior changes, suicidal thoughts or actions, severe allergic reactions. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | Adults and children over 6: Start at 300 mg twice a day, up to a max of 2400 mg/day for adults and 1800 mg/day for children. | Starts at 500 mg twice per day, up to a maximum daily dose of 3000 mg. |
What is Trileptal?
Oxcarbazepine (the generic name for Trileptal) is part of the anticonvulsant class of medications, which marked a significant development following the first generation of antiepileptic drugs. Oxcarbazepine was first approved by the FDA in 2000. Trileptal works by decreasing nerve impulses that cause seizures and pain. It is prescribed for both partial seizures and generalized tonic-clonic seizures in individuals with epilepsy.
On the other hand, Levetiracetam (the generic name for Keppra), another member of the anticonvulsant class, has somewhat different mechanisms but shares many similarities with Oxcarbazepine. Keppra also treats multiple types of epileptic seizures but its exact mechanism remains unknown—it's believed to influence neurotransmitter activity without directly affecting GABA or glutamate receptor function.
Both these medications have side effects; however, they vary between patients—Trileptal can lead to dizziness and double vision while Keppra may result in fatigue and behavioral changes.
What conditions is Trileptal approved to treat?
Trileptal and Keppra are both approved for different types of seizure disorders:
- Trileptal (oxcarbazepine) is indicated as monotherapy or adjunctive therapy in the treatment of partial seizures in adults and children aged 4 years above.
- Keppra (levetiracetam) is used to treat various types of epilepsy. It can be used alone or combined with other medications to control seizures in adults and children who are at least one month old.
How does Trileptal help with these illnesses?
Trileptal helps manage seizures by decreasing the excessive electrical activity in the brain that leads to these conditions. It does this by blocking voltage-sensitive sodium channels, which are responsible for the propagation of action potentials in neurons. These action potentials are essentially signals or messages that travel throughout our nervous system, allowing us to react and respond to different stimuli. When too many of these signals occur at once, it can lead to a seizure. Trileptal prevents this from happening by stabilizing hyperactive nerve cells and reducing their ability to fire off excess signals.
Keppra also works on managing seizures but uses a different mechanism than Trileptal; instead of targeting sodium channels like Trileptal, Keppra binds SV2A, a protein found in synaptic vesicles in neurons throughout the nervous system. This binding is believed to play an important role in modulating neuronal excitability and inhibiting seizure activity.
Both drugs aim at preventing over-excitation within the brain's network but have distinct mechanisms of action which might make one more suitable depending on individual patient factors.
What is Keppra?
Keppra is a brand name for levetiracetam, which is an anticonvulsant medication used to treat epilepsy. Keppra works by decreasing abnormal excitement in the brain. It was first approved by the FDA in 1999 and can be employed as monotherapy or adjunctive therapy in the treatment of partial onset seizures, myoclonic seizures and primary generalized tonic-clonic seizures.
Unlike other anti-epilepsy drugs, Keppra does not work by interacting with specific neurotransmitters or receptors in the brain; its exact mechanism of action remains unknown. This may contribute to its unique side-effect profile compared to other antiepileptic drugs such as Trileptal (oxcarbazepine). Notably, while it can cause drowsiness and weakness much like Trileptal, it's less likely to cause serious skin reactions – a potential risk with oxcarbazepine use.
The effects of Keppra can be beneficial for patients who do not respond well to typical anti-epileptic medications or cannot tolerate their side effects.
What conditions is Keppra approved to treat?
Keppra is an anticonvulsant that has been approved for use in managing:
- Epilepsy, specifically partial onset seizures, both as monotherapy and adjunctive therapy
- Primary generalized tonic-clonic seizures as an adjunctive therapy
- Myoclonic seizures in patients with juvenile myoclonic epilepsy.
How does Keppra help with these illnesses?
Levetiracetam, commonly known as Keppra, is a drug used primarily for the treatment of epileptic seizures. It works by modulating neurotransmitter release in the brain, particularly GABA and glutamate, which play vital roles in regulating excitability within the nervous system. This action helps to prevent abnormal electrical activity that leads to seizures. Unlike Trileptal (oxcarbazepine), which also stabilizes neuronal membranes but can cause more side effects such as dizziness or double vision, Keppra has been noted for its relatively good tolerability and fewer drug interactions. Due to these attributes, it might be prescribed when a patient does not respond well to other antiepileptic drugs or needs combination therapy for adequate seizure control.
How effective are both Trileptal and Keppra?
Both oxcarbazepine (Trileptal) and levetiracetam (Keppra) have established histories of success in treating patients with epilepsy, though they were approved by the FDA years apart. Since they act on different channels and receptors within the nervous system, they may be prescribed under different circumstances. The effectiveness of Trileptal and Keppra in controlling seizures was directly studied in multiple clinical trials; these two drugs exhibited similar efficacy in managing symptoms of epilepsy as well as similar safety profiles.
A 2001 review demonstrated that Trileptal is effective at reducing seizure frequency starting from the first week of treatment, its side effect profile is favorable over many other antiepileptic drugs, and that it can be used safely even in pediatric populations. This study reports that Trileptal has become a frequently prescribed antiepileptic drug worldwide due to its beneficial pharmacokinetic properties including minimal drug interactions.
On the other hand, a 2016 review indicated that Keppra seems to be more effective than placebo for partial onset seizures, juvenile myoclonic epilepsy and primary generalized tonic-clonic seizures. Despite this strong efficacy data for certain types of epilepsy, there are particular concerns about behavioral adverse effects associated with Keppra use which might limit its applicability or require co-prescription with mood stabilizers or psychiatric medications. Nonetheless, due to its unique mode of action involving binding to synaptic vesicle protein SV2A – unlike most other anti-epilepsy drugs - Keppra may prove optimal for patients who did not respond well to traditional sodium channel blocking medicines or have a requirement to avoid common side effects related with older generation antiepileptic drugs.
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At what dose is Trileptal typically prescribed?
Oral dosages of Trileptal for adults and children over the age of 6 begin at 300 mg twice a day. However, studies have indicated that this may be adjusted by increments of 600 mg/day at approximately weekly intervals to achieve optimal clinical response. For pediatric patients aged between 2-5 years old, the recommended total daily dose is 60 mg/kg divided into two doses. In either population, dosage can be increased after a few weeks if there is no response. The maximum dosage for adults should not exceed 2400 mg/day and for children (under the age of 16), it should not surpass 1800 mg/day.
On the other hand, Keppra's oral dosages for adult epilepsy treatment start from initial dose of 500mg twice a day which can increase up to maximum limit of 1500mg twice a day based on individual therapeutic response. For paediatric patients (1 month - <16 years), initial recommended dose is about roughly between ~20mg/kg/day to ~30mg/kg/day depending upon their body weight with an increment possible every two weeks upto max limit ranging from ~40mg/kg/day to ~60mg/kg/day as per patient's weight range.
At what dose is Keppra typically prescribed?
Keppra treatment typically begins with a dosage of 500 mg twice per day. The dose may then be increased to a maximum daily dose of 3000 mg, divided into two doses, spaced approximately 12 hours apart. If there is no sufficient response to the initial Keppra treatment after some time, an increase in dosage up to the maximum recommended amount can be considered under medical supervision. It's crucial not to self-adjust your dosage but consult your healthcare provider for any modifications necessary based on your unique condition and response to treatment.
What are the most common side effects for Trileptal?
Common side effects of Trileptal (oxcarbazepine) include:
- Dizziness
- Sleepiness/drowsiness
- Fatigue
- Nausea and vomiting
- Ataxia (impaired coordination)
- Double vision, blurry vision or other visual disturbances
- Tremor (unintentional trembling or shaking)
- Abdominal pain
- Diarrhea
On the other hand, common side effects of Keppra (levetiracetam) include:
- Somnolence/sleepiness
- Asthenia/weakness
- Infection
- Dizziness
- Anxiety and nervousness
- Hostility and irritability
- Depression or mood swings
Both medications may increase the risk for suicidal thoughts and behavior. If you notice any new signs of depression, anxiety, agitation, panic attacks, insomnia, irritability, aggressive behavior or if you have thoughts about self-harm or suicide while taking either medication – get medical help immediately.
Are there any potential serious side effects for Trileptal?
While both Trileptal and Keppra are generally well-tolerated, there can sometimes be serious side effects. These could include:
- Thoughts about suicide or self-harm
- Signs of allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions like rashes that blister and peel
- Vision problems such as blurred vision or unusual eye movements
- Rapid heartbeats, chest fluttering, shortness of breath, and sudden dizziness - feeling like you might pass out
- Low sodium levels in the body. Symptoms may include nausea, headache, confusion, tiredness/fatigue weakness/spasms/cramps
- Severe nervous system reaction: stiff muscles; fever; sweating; fast/irregular heartbeat; jerky muscle movements you cannot control.
For Keppra specifically:
Any symptoms of a severe mood disorder: increased aggression/hostility/agitation/anxiety/anger/depression/suicidal thoughts/attempts
If these occur while taking either medication it's important to contact your healthcare provider right away.
What are the most common side effects for Keppra?
Some common side effects of Keppra (levetiracetam) that you should be aware of include:
- Drowsiness, fatigue or weakness
- Loss of appetite
- Nausea or vomiting
- Dizziness and headache
- Mood swings, feeling agitated or hostile at times
- Unusual changes in behavior, including confusion
- Coordination problems which might lead to unsteady walk
- Muscle weakness or pain.
In rare cases, skin rash can occur as well. It's essential to keep a track on these symptoms while taking Keppra and consult your healthcare provider if any of these worsen over time.
Are there any potential serious side effects for Keppra?
While Keppra is generally safe and effective for managing seizures, it's vital to stay alert for potential adverse reactions. These may include:
- Signs of an allergic reaction: such as hives, difficulty breathing or swallowing, swelling in the face or throat
- Changes in mood or behavior like agitation, hostility, depression
- Hallucinations or confusion
- Extreme drowsiness accompanied by weak or shallow breathing
- Coordination problems leading to unsteady movement
- Flu-like symptoms with fever, chills and body aches
- Rapid eye movement back and forth without control (nystagmus)
If you notice any of these signs while taking Keppra, seek immediate medical attention.
Contraindications for Trileptal and Keppra?
Both Trileptal and Keppra, like many other antiepileptic drugs, may increase the risk of suicidal thoughts or behavior in some people. If you notice an increase in such feelings or actions while taking either medication, please seek immediate medical attention.
Neither Trileptal nor Keppra should be taken if you are currently using, or have recently used, any type of monoamine oxidase (MAO) inhibitors. Always inform your healthcare provider about all medications you are taking; MAOIs will require a period of about two weeks to clear from your system to prevent hazardous interactions with both Trileptal and Keppra.
Moreover, these medications should not be stopped suddenly without consulting with your doctor as this can trigger withdrawal symptoms and potentially lead to seizures. It is important to follow the treatment plan provided by your healthcare provider when it comes to dose adjustments or discontinuation of these drugs.
How much do Trileptal and Keppra cost?
For the brand-name versions of these drugs:
- The price of 60 tablets of Trileptal (300 mg) averages around $500, which works out to between $16–32/day, depending on your dose.
- The price for a similar quantity of Keppra (500 mg), is about $850, working out to approximately $28/day.
Thus, if you're in the higher dosage range for Trileptal (i.e., 1200 mg/day or higher), then brand-name Keppra can potentially be less expensive on a per-day treatment basis. However, cost should not be your primary consideration when determining which medication is most suitable for you.
When it comes to generic forms:
- Oxcarbazepine (a generic form of Trileptal) costs around $1.50 - $2 per day for dosages between 600 and 2400 mg.
- Levetiracetam (generic form of Keppra) has a lower approximate cost ranging from about $0.80 –$3 per day depending on whether you are taking between 1000mg and up to even 3000mg daily.
Again remember that pricing may vary based on location and insurance coverage among other factors. Always consult with your healthcare professional before making any decisions regarding medications.
Popularity of Trileptal and Keppra
Oxcarbazepine, available under the brand name Trileptal among others, was estimated to have been prescribed to about 1.3 million people in the US in 2020. Oxcarbazepine accounted for approximately 8% of anticonvulsant prescriptions in the US. This medication is often used as a monotherapy or adjunctive therapy in treating partial seizures and generalized tonic-clonic seizures.
On the other hand, Levetiracetam, also known by its brand name Keppra, had over 10 million prescriptions filled out across America during that same year. In terms of overall usage amongst antiepileptic drugs (AEDs), levetiracetam accounts for roughly 17%. It's frequently utilized not only for partial onset seizures but also myoclonic and tonic-clonic seizures. Over time there has been a general increase in prescription rates for this medication due to its broad-spectrum efficacy and good tolerability profile.
Conclusion
Both Trileptal (oxcarbazepine) and Keppra (levetiracetam) have been used for many years in patients with epilepsy, and are supported by extensive clinical studies showing that they are more effective than placebo treatment. In certain cases, the drugs may be combined to achieve better seizure control; however, such combinations must be carefully considered by a physician as there can be drug interactions. Due to their different mechanisms of action - Trileptal works by blocking voltage-sensitive sodium channels, while Keppra inhibits synaptic vesicle protein SV2A - they tend to be prescribed under different circumstances. Both drugs are considered first-line treatments for partial onset seizures.
Both medications come in generic form which represents significant cost savings especially for patients who must pay out of pocket. An adjustment period may also apply when beginning these treatments, meaning effects may not always be noticeable right away.
The side effect profile is similar between the two drugs: both being generally well-tolerated but with some differences – dizziness and drowsiness are common with Trileptal whereas behavioral changes like irritability or aggression might occur more frequently with Keppra. For both medications, patients should monitor their health closely when starting therapy and should seek medical help immediately if they notice worsening symptoms or new types of seizures.
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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
- Rigo, J., Hans, G., Nguyen, L., Rocher, V., Belachew, S., Malgrange, B., … Klitgaard, H. (2002, July). The anti‐epileptic drug levetiracetam reverses the inhibition by negative allosteric modulators of neuronal GABA‐ and glycine‐gated currents. British Journal of Pharmacology. Wiley.http://doi.org/10.1038/sj.bjp.0704766
- Bang, L. M., & Goa, K. L. (2004). Spotlight on Oxcarbazepine in Epilepsy1. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200418010-00006
- Sirsi, D., & Safdieh, J. E. (2007, May). The safety of levetiracetam. Expert Opinion on Drug Safety. Informa Healthcare.http://doi.org/10.1517/14740338.6.3.241
- Flesch, G. (2004). Overview of the Clinical Pharmacokinetics of Oxcarbazepine. Clinical Drug Investigation. Springer Science and Business Media LLC.http://doi.org/10.2165/00044011-200424040-00001
- 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