Desitrend® Levetiracetam granules, from Desitin Pharma UK, are formulated to help improve patient adherence to their prescribed anti-seizure medication (ASM). The granules (which can be taken with food or dissolved in 10ml of water) are particularly suitable for children under 12 years with epilepsy, and patients who require a feeding tube, have dysphagia (or are unable to swallow tablets) or are on a low carbohydrate or ketogenic diet.
Vulnerable patient groups with epilepsy, including people with a learning disability (LD) and those who have had a stroke may also benefit from Desitrend® Levetiracetam granules. Almost 25% of people with epilepsy have a learning disability, [Sun, 2023]. Despite being prescribed an ASM, they are significantly more likely to have seizures than patients without a LD. The percentage of patients with LD, with a record of seizure frequency was 30.4% in 2018-19 compared to 9.0% in those without, [NHS England, 2021].
Patients with epilepsy and a LD are also more likely to have dysphagia. Data on the prevalence of dysphagia in people with learning disabilities range from 36% to over 70%, [Public Health England, 2016]. This means they may struggle to swallow tablets and issues with medicine adherence are common in people with learning disability. One study estimated that only 12.4% were fully adherent to their prescribed medication, [Huang, 2019] and non-adherence may be compounded by dysphagia [Blaszczyk, 2023].
Stroke is the leading cause of seizures and epilepsy in older adults with an estimated incidence of between 6.4% – 15%, [Galovic, 2021]. Management aims to establish a therapeutic response at the lowest viable dose [Galovic, 2021] and many patients with post-stroke epilepsy respond well to even low dose treatment, meaning dosage accuracy is essential. Soluble medications are likely to be useful for stroke patients with dysphagia, [Galovic, 2021].
Desitrend® Levetiracetam coated granules in sachets, can be taken with a small volume of liquid (10ml) or mixed with food. This avoids the need for food thickeners which, when added to a liquid medicine to aid swallowing, can delay or reduce it’s absorption and efficacy. The granules are therefore suitable for patients with epilepsy who are unable to swallow tablets, or who may be at risk of aspiration pneumonia from large volumes of liquid; as well as children under 12 who require a precisely measured dose and may be unwilling or unable to swallow tablets.
Desitrend® is the only formulation of levetiracetam which is licensed for administration through a feeding tube and NEWT Guidelines recommend Desitrend® as the first choice for patients with swallowing difficulties.
The innovative granules are available in three strengths – 250, 500 and 1000mg, offering dosage precision. Desitrend is effective and well-tolerated, [Ries, 2012]. In a non-interventional study, 395 patients with epilepsy were documented in 82 study centres. The treating physicians concluded that Desitrend may offer the opportunity to improve compliance for the long-term treatment of patients with epilepsy, [Ries, 2012].
It should be noted that in March 2023, an unbranded formulation ‘levetiracetam granules for oral solution’ became available, which has significant differences to Desitrend coated granules, including the volume of water needed to take it, the nature of excipients and method of administration. These granules should be dissolved in 250ml of water, making this unsuitable for patients with dysphagia. They are not carbohydrate-free, so are not suitable for patients on a ketogenic diet; and are not licensed to be administered via a feeding tube. So, if Desitrend coated granules have been prescribed for specific clinical reasons, there can be issues if levetiracetam granules are prescribed generically. The differences are not obvious at the point of dispensing and patients may inadvertently receive the granules “for oral solution”, which may be unsuitable for meeting their clinical needs.
For more information contact: Desitin at [email protected]
References
Blaszczyk A, Brandt N, Ashley J, Tuders N, Doles H, Stefanacci RG. Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding: Challenges and Considerations. Drugs Aging. 2023;40(10):895-907.
Galovic M, Ferreira-Atuesta C, Abraira L, et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs Aging. 2021;38(4):285-299. doi:10.1007/s40266-021-00837-7.
Huang J, Jiang Z, Zhang T Which Matters More for Medication Adherence Among Disabled People in Shanghai, China: Family Support or Primary Health Care?. Inquiry. 2019;56 https://doi.org/10.1177/0046958019883175
The NEWT Guidelines for administration of medication to patients with enteral feeding tubes or swallowing difficulties. https://www.newtguidelines.com/GeneralGuidance.html accessed 170624.
NHS England Health and Care of People with Learning Disabilities Experimental Statistics 2019-2020, published 28 January 2021 https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/experimental-statistics-2019-to-2020/adhd-autism-and-epilepsy#epilepsy-currently-on-drug-treatment-for-epilepsy-and-have-a-seizure-frequency-record-at-the-end-of-the-reporting-period accessed 170624.
Public Health England, 2016, Dysphagia in people with learning difficulties: reasonable adjustments guidance https://www.gov.uk/government/publications/dysphagia-and-people-with-learning-disabilities/dysphagia-in-people-with-learning-difficulties-reasonable-adjustments-guidance accessed 170624.
Ries, S. & Reifschneider, G. & Scheer, W.. (2012). Levetiracetam minitablets: Innovative formulation promotes compliance in patients with epilepsy. Non-interventional study to evaluate the safety, feasibility and compliance of levetiracetam minitablets in patients with epilepsy (LEV 003/K). Psychopharmakotherapie. 19. 260-264.
Sun JJ, Watkins L, Henley W, et al. Mortality risk in adults with intellectual disabilities and epilepsy: an England and Wales case-control study. J Neurol. 2023;270(7):3527-3536.
Desitin Pharma is a European pharmaceutical company with a 100 year history of research and development for the innovative management of neurological disorders, particularly in the fields of epilepsy and Parkinson’s syndrome.
Link to SmPC: https://www.medicines.org.uk/emc/product/2883/smpc#gref
Prescribing information can be found HERE.
