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Neurontin vs Keppra
Introduction
For patients with epilepsy or other types of seizure disorders, certain drugs that influence the activity of nerve signals in the brain can help control seizures and manage symptoms. Neurontin (gabapentin) and Keppra (levetiracetam) are two such drugs that are often prescribed for these conditions. They each impact different aspects of neuronal excitability, but both have effects in reducing seizure frequency in patients with epileptic disorders. Neurontin is a type of anticonvulsant medication that works by calming down nerve activity, specifically targeting GABA neurotransmitters to reduce excessive electrical brain activity. On the other hand, Keppra belongs to a newer class of anti-seizure medications and its exact mechanism isn't entirely understood yet; however, it's thought to act on synaptic vesicle protein SV2A within neurons which likely helps regulate nervous system excitability.
What is Neurontin?
Gabapentin (the generic name for Neurontin) is an anticonvulsant medication, a class of drugs originally developed to treat epilepsy but now also used for various forms of neuropathic pain. It was first approved by the FDA in 1993. Neurontin works by affecting the neurotransmitters that send signals from nerve cells to your brain, effectively "calming" or "damping down" these nerves and reducing their ability to transmit pain signals. It's prescribed mostly for postherpetic neuralgia and partial seizures.
On the other hand, Levetiracetam (generic name for Keppra) belongs to a newer generation of antiepileptic drugs designed with improved efficiency and fewer side effects in mind. Keppra has been shown to have less interaction with other medications and minimal impact on liver enzymes, which can make it better tolerated than older medicines like gabapentin.
Comparatively speaking, Gabapentin has a more specific mechanism focusing on calming overactive nerves while levetiracetam exerts its influence broadly across multiple pathways involved in seizure activity resulting in greater efficacy but potential for more diverse side effects.
What conditions is Neurontin approved to treat?
Neurontin is approved for the management of several conditions:
- Postherpetic neuralgia, a type of nerve pain caused by shingles
- Partial onset seizures in adults and children 3 years of age and older with epilepsy
- Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization, in adults and pediatric patients 3 years and older with epilepsy.
On the other hand, Keppra is used to treat:
- Partial onset seizures in people one month of age or older
- Primary generalized tonic-clonic seizures in people six years old or above
- Myoclonic seizures (sudden jerks) related to juvenile myoclonic epilepsy from twelve years old onwards.
How does Neurontin help with these illnesses?
Neurontin, also known as gabapentin, helps to manage seizures and nerve pain by altering the way the body senses pain and by stabilizing electrical activity in the brain. It does this by binding to specific sites on voltage-gated calcium channels within the nervous system. This action decreases certain types of nerve signals and inhibits synaptic transmission - communication between neurons - thereby reducing seizures and postherpetic neuralgia symptoms. On the other hand, Keppra or levetiracetam is thought to work differently although its exact mechanism of action isn't completely understood. It has been theorized that it influences a neurotransmitter called GABA (gamma-aminobutyric acid), which plays a crucial role in calming overexcited nerves in your brain – therefore helping reduce seizure occurrences. Both Neurontin and Keppra are used for different conditions but both aim at regulating neuronal activities for better patient outcomes.
What is Keppra?
Keppra, also known as levetiracetam, is an antiepileptic drug that differs considerably from Neurontin (also known as gabapentin). Levetiracetam has a unique mechanism of action where it binds to the synaptic vesicle protein SV2A in the brain. This binding helps reduce nerve conduction and hence prevents seizures. Approved by the FDA in 1999, Keppra does not work like traditional seizure medications and is not believed to directly affect GABA or glutamate receptor activity, two common targets for such drugs.
Its distinct mode of action means its side effect profile is somewhat different than other anti-seizure drugs such as Neurontin. While both can cause drowsiness or dizziness, Keppra has been associated with mood changes and behavioral issues more frequently than many other similar medications including Neurontin. Despite these potential effects on mood, many patients find that they respond well to Keppra when conventional seizure medications have failed them.
What conditions is Keppra approved to treat?
Keppra is a widely used anti-epileptic drug, or AED. The FDA has approved it for the management of:
- Partial onset seizures in adults and children aged 1 month and older
- Myoclonic seizures in patients who are at least 12 years old with juvenile myoclonic epilepsy
- Primary generalized tonic-clonic seizures in adults and children aged 6 years and older with idiopathic generalized epilepsy
How does Keppra help with these illnesses?
Levetiracetam, also known as Keppra, is a drug that plays significant roles in the central nervous system by modulating synaptic neurotransmission, ultimately affecting cognitive processes such as memory recall and attention. It's heavily utilized in managing epilepsy and seizures because it works by stabilizing electrical activity in the brain. Unlike Neurontin (Gabapentin), which primarily binds to voltage-gated calcium channels to decrease excitability and neuropathic pain, Keppra has a unique impact on synaptic vesicle protein SV2A - this makes it beneficial for patients who may not respond well enough to other anti-epileptic drugs or those needing combination therapy for better seizure control. While both medications are used in neurological disorders, their distinct modes of action allow physicians flexibility when prescribing based on individual patient needs.
How effective are both Neurontin and Keppra?
Both gabapentin (Neurontin) and levetiracetam (Keppra) have built a solid reputation for their effectiveness in managing epileptic seizures, with both drugs getting FDA approval only two years apart. They work on different pathways within the central nervous system, thus may be prescribed under varying conditions. The efficacy of Neurontin and Keppra in controlling seizures was investigated directly via a comparative study conducted in 2001; where both medications were noted to exhibit comparable proficiency at seizure management along with promising safety profiles.
A comprehensive analysis carried out in 2009 reported that gabapentin effectively mitigates the frequency of focal seizures from its initiation stages, showcases an advantageous side effect profile over many other antiepileptic drugs, and is well tolerated across diverse population groups including children and elderly patients. Furthermore, following its development as one among the first generation of non-sedative anticonvulsants, there exists substantial research regarding its use for treating epilepsy.
On the other hand, a review conducted in 2017 indicated that levetiracetam has shown superior effectiveness compared to placebo treatments when it comes to reducing seizure frequency and can stand toe-to-toe with other commonly used anti-epileptics when it comes to efficacy. Although usually considered after or as an addition to initial treatment options like carbamazepine or valproate due to cost considerations or specific clinical scenarios. Nevertheless owing to its unique mechanism of action not involving direct interaction with GABA receptors unlike most anti-epileptics , Levetiracetam could possibly be an optimal choice for patients who did not respond well or are intolerant towards older generation drugs.
At what dose is Neurontin typically prescribed?
Oral dosages of Neurontin start from 300 mg/day, which can be sufficient for managing nerve pain in some individuals. For epilepsy, the dose is usually started at a lower point and increased gradually to reduce side effects. The maximum dosage that should not be exceeded is 3600 mg/day. On the other hand, oral doses of Keppra for adults typically range between 1000-3000 mg/day divided into two doses. Children's dosage depends on body weight and starts at around 20mg/kg per day also divided into two doses. As with most medications, it may take several weeks to see an effect and dosage adjustments may be required based upon individual response and tolerability.
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At what dose is Keppra typically prescribed?
Keppra treatment is typically initiated with a dosage of 500 mg twice per day. If necessary, the dose can be increased to 1000 mg twice daily after two weeks. The maximum recommended dose for Keppra is 3000 mg/day divided into two doses of 1500 mg each and taken 12 hours apart. This higher dose may be considered if there's no significant improvement observed at the lower doses over a reasonable period of time.
What are the most common side effects for Neurontin?
Common side effects of Neurontin (Gabapentin) and Keppra (Levetiracetam), two medications commonly used to control seizures, can include but are not limited to:
- Dizziness
- Somnolence (sleepiness/drowsiness)
- Fatigue or general weakness
- Unsteady movement or tremor
- Anxiety
- Nausea and/or vomiting
- Indigestion or discomfort in the digestive tract
- Diarrhea
- Dry mouth and throat issues like pharyngitis (inflammation at the back of the throat)
- Rash or other skin reactions Interestingly, both drugs may cause mood changes such as nervousness and abnormal behavior. While sexual side effects are less common with these medications compared to some others, if you experience any unusual symptoms while taking either drug, it's crucial to report them to your healthcare provider promptly.
Are there any potential serious side effects for Neurontin?
Neurontin and Keppra are both used to control seizures in people with epilepsy, but they can have different side effects. Neurontin, for instance, may lead to:
- Increased thoughts of suicide or self-harm
- Signs of a severe allergic reaction such as rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
- Troubles with coordination or balance
- Unusual eye movements
- Swollen glands (lymph nodes)
- Unexplained fever
Keppra on the other hand has been known to cause:
- Mood swings that include suicidal thoughts and tendencies
- Severe skin reactions characterized by rashes and peeling skin
- Changes in behavior such as aggression and irritation
- Symptoms related to infection like sore throat and fever
- Coordination problems coupled with feeling tired or drowsy.
If you experience any of these symptoms while taking either medication, it's crucial that you seek medical attention immediately.
What are the most common side effects for Keppra?
When it comes to Keppra, there are several possible side effects you should be aware of:
- Drowsiness or fatigue
- Dizziness or spinning sensation
- Nausea and vomiting
- Feeling weak or unsteady
- Changes in mood or behavior, such as aggression, agitation, apathy, irritability and depression
- Problems with muscle coordination (feeling unsteady while walking)
- Rash
- Headache It's important also to note that some patients have reported experiencing a decrease in appetite which may lead to weight loss. This is not an exhaustive list however; if any other symptoms arise after starting on Keppra treatment, consult your healthcare provider immediately.
Are there any potential serious side effects for Keppra?
While Keppra is generally well-tolerated, it's crucial to be aware of potential serious side effects. These may include:
- Signs of a severe allergic reaction such as difficulty breathing; swelling in your face or throat; hives; skin pain, followed by a red or purple skin rash that spreads and causes blistering and peeling.
- Increased suicidal thoughts or behaviors, unusual changes in mood such as being overly aggressive, angry, or agitated.
- Unusual changes in movements such as uncontrolled eye movement and tremors which could signal possible new or worsening seizures.
- Serious dermatologic reactions like Stevens-Johnson syndrome (SJS) characterized by fever with sore throat/burning eyes/skin pain followed by a widespread painful rash full of fluid-filled blisters
- Changes in mental status including hallucinations, confusion, extreme drowsiness
- Kidney problems - little to no urination; painful/difficult urination; swelling in feet/ankles
If you experience any of the above symptoms while on Keppra, seek immediate medical attention.
Contraindications for Neurontin and Keppra?
Both Neurontin and Keppra, along with most other antiepileptic medications, may worsen symptoms of depression in some people. If you notice your mood declining, or an increase in suicidal ideation, thoughts, or behavior while taking these drugs, it is essential to seek immediate medical attention.
Neither Neurontin nor Keppra should be taken if you are using any kind of strong opioid pain reliever such as fentanyl without consulting your doctor first. It's critical to inform your physician about all the medications you're currently on; certain opioids can interact dangerously with Neurontin and Keppra. Always discuss potential interactions before starting a new prescription medication regimen.
How much do Neurontin and Keppra cost?
For the brand name versions of these antiepileptic drugs:
- The price for 60 tablets of Neurontin (300 mg) averages around $400 which works out to approximately $13–$26/day, depending on your dose.
- The price for 60 tablets of Keppra (500 mg) is about $840, working out to roughly $28/day.
This indicates that if you are in the higher dosage range for Neurontin (i.e., 900 mg/day or higher), then brand-name Keppra may be more expensive on a per-day treatment basis. As always, cost should not be considered as the primary factor when deciding between these medications.
For their generic versions:
- Gabapentin, which is generic Neurontin, comes in packs from 30 capsules and upwards with costs ranging between $0.30 to $1 per day for doses ranging from 300mg/day up to 900mg/day or more.
- Levetiracetam, generic version of Keppra; prices also vary broadly based on quantity but typically can run anywhere from about $0.50 up to over $2 per day at typical doses that might reach as high as two grams daily.
Popularity of Neurontin and Keppra
Gabapentin, under the brand name Neurontin, was prescribed to an estimated 46 million people in the US in 2020. Gabapentin is used primarily to manage seizures and neuropathic pain. It's not classified as a traditional antiepileptic drug but rather as an analgesic. The prescription of gabapentin has seen a steady increase since its introduction due to its off-label use for various painful conditions.
Levetiracetam, sold under the brand name Keppra among others, was prescribed to approximately 3 million people in the USA during 2020. Levetiracetam accounts for about 7% of total AED (antiepileptic drugs) prescriptions in the United States and it falls into a newer generation of AEDs with improved safety profiles compared to older options. The prevalence of levetiracetam prescriptions has been gradually increasing over time due largely to better tolerability and less drug interactions.
Conclusion
Both Neurontin (gabapentin) and Keppra (levetiracetam) are widely used in the management of epilepsy, with numerous clinical studies backing their effectiveness over placebo treatments. In some instances, these medications may be combined to enhance therapeutic efficacy but this is subject to careful evaluation by a healthcare provider due to potential drug interactions. The two drugs work through different mechanisms: Neurontin primarily acts on voltage-gated calcium channels while Keppra influences synaptic vesicle protein SV2A, hence they may be prescribed under varying circumstances.
Keppra is often considered as a first-line treatment option for certain types of seizures whereas Neurontin might typically be added onto other seizure medications or used when patients did not respond well to first-line antiepileptics or need to avoid certain side effects associated with them.
Both drugs are available in generic forms providing significant cost savings especially for uninsured patients. There might also be an adjustment period required after initiating either medication before full benefits can be experienced.
The side effect profile between the two varies slightly; both are generally well tolerated but drowsiness and fatigue could potentially occur more frequently with Neurontin than with Keppra. For both drugs, patients must closely monitor any changes in their seizure frequency or new onset symptoms and should immediately report such occurrences to their healthcare provider.