Challenge to levetiracetams de facto position as generic first-line antiseizure medication

Since its inauspicious beginnings as an unsuccessful cognitive-enhancing drug and disappointing impact on animal seizure models in the 1990s, levetiracetam has gone from strength to strength, becoming an antiseizure ‘blockbuster’ with yearly sales of over 1 billion dollars in the USA.1 Following its licensing for focal-onset seizures in 1999 in the USA and 2000 in Europe, the use of levetiracetam has escalated2 3 to the point that it is now among the most commonly prescribed antiseizure medications in resource-rich countries. Indeed, it is best known by its brand name, resulting in large numbers of prescriptions for branded Keppra rather than the much cheaper levetiracetam.

A convergence of factors has catapulted levetiracetam to the top of the antiseizure medication armamentarium, including a simple dosing regimen, lack of clinically meaningful drug interactions and skilful marketing. Its increasing familiarity among medical specialities has led to its creeping use in…

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