The U.S. Food and Drug Administration has approved administration of Spritam (levetiracetam) via nasogastric and gastrostomy tubes, marking a significant advancement for epilepsy patients who cannot take oral medications. Spritam, manufactured by Aprecia Pharmaceuticals, is the world's first FDA-approved three-dimensionally printed medication produced at commercial scale.
The approval makes Spritam the only levetiracetam formulation with FDA-approved labeling for NG-tube and G-tube administration, addressing a critical unmet need for patients with swallowing difficulties or those requiring enteral feeding support.
Revolutionary 3D Printing Technology
Aprecia's proprietary ZipDose Technology Platform enables the creation of rapidly disintegrating oral dosage forms that break apart in seconds with minimal liquid volumes. The company's multi-patented, binder-jetting manufacturing system allows for precise drug delivery through multiple administration routes using a single formulation.
"Aprecia's advanced manufacturing technology enables disintegration in minimal fluid volumes, supporting multiple oral administration routes and enhancing patient accessibility through a single, adaptable formulation," said Kyle Smith, President and Chief Operating Officer at Aprecia.
Clinical Significance for Epilepsy Treatment
Levetiracetam serves as a first-line therapy for partial onset seizures in patients 4 years and older. The new administration route provides essential treatment access for patients with complex medical needs who cannot take medications orally.
"Levetiracetam is a first-line therapy for partial onset seizures in patients 4 years and up and its accessibility for patients with swallowing challenges is critical. Aprecia is committed to improving access and flexibility for patients with complex medical needs," Smith explained.
Administration Protocol and Safety Data
The approval is based on Aprecia data confirming that Spritam can be effectively delivered through NG and G-tube sizes appropriate for all indicated age groups. When dispersed in a dosing cup and administered via feeding tubes, the formulation maintains consistent delivery characteristics suitable for enteral administration.
"Our data demonstrated that, when dispersed in a dosing cup and administered via nasogastric or gastrostomy tube, the formulation maintains consistent delivery characteristics appropriate for enteral administration," said Kathi Rinesmith, R.Ph, MS, Senior Vice President Scientific Affairs at Aprecia.
For tube administration, healthcare providers place whole tablets in a dosing cup with approximately 10 mL of room temperature water, gently swirl until tablets disperse, then draw the mixture into a 10 mL oral catheter-tip syringe for immediate administration through the feeding tube. The tube requires flushing twice with additional 10 mL water portions to ensure complete dose delivery.
Therapeutic Indications and Patient Population
Spritam is indicated for treating partial-onset seizures in patients 4 years and older, myoclonic seizures in patients 12 years and older with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients 6 years and older with certain types of generalized epilepsy. The medication is recommended for patients weighing more than 44 pounds (20 kilograms).
The drug can now be administered through three distinct methods: dissolving on the tongue with liquid, dispersed in a cup as an oral suspension, or dispersed and administered via feeding tubes.
Safety Profile and Monitoring
Clinical trials identified common adverse reactions in adults including sleepiness, weakness, dizziness, and infection. Pediatric patients additionally experienced tiredness, aggressive behavior, nasal congestion, decreased appetite, and irritability.
Healthcare providers must monitor for serious risks including suicidal thoughts or actions (occurring in approximately 1 in 500 patients), severe allergic reactions, serious skin rashes, and coordination problems. The medication carries warnings against abrupt discontinuation due to seizure rebound risk.
Manufacturing Innovation Impact
Founded in 2003, Aprecia received the first FDA approval for a three-dimensionally printed pharmaceutical product in 2015. The company licenses its exclusive technology platform to pharmaceutical partners for product line extensions and improved patient accessibility, including pediatric dosage form options to meet FDA pediatric study requirements.
