LEVETIRACETAM

Levetiracetam Overview

Levetiracetam is a widely used prescription antiepileptic medicine. Neurologists, emergency room doctors, and primary care providers prescribe this medication to prevent and control several different types of seizures in both adults and children.

Key Facts Summary:

What Is Levetiracetam and How Does It Work?

Levetiracetam is a single active ingredient medication that works differently from many older seizure drugs.

Mechanism of Action

During a seizure, brain cells fire uncontrolled electrical signals at a very fast rate. Most older seizure medicines work by blocking sodium or calcium channels on the outside of the nerve cells.

Levetiracetam works on the inside of the cell. It attaches to a specific protein called synaptic vesicle protein 2A (SV2A). This protein helps package and release chemical messengers (neurotransmitters) between brain cells. By binding to SV2A, Levetiracetam slows down the release of these chemicals, which stops the rapid, abnormal electrical signals from spreading across the brain.

Is Levetiracetam FDA Approved?

Yes, Levetiracetam is officially approved by the United States Food and Drug Administration. It is one of the most commonly prescribed seizure medications worldwide because it works well and does not interact with many other drugs.

What Is Levetiracetam Used For?

• Treatment of focal seizures (partial-onset seizures) in adults and children 1 month of age and older.
• Treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy.
• Treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy.

Before Taking Levetiracetam: Contraindications and Precautions

Your medical team will check your kidney function and review your mental health history before prescribing this drug, as it can cause significant mood changes in some people.

Who Should Not Take Levetiracetam?

• Anyone with a known severe hypersensitivity or allergic reaction to Levetiracetam or any of its inactive ingredients.

Levetiracetam, Pregnancy and Fertility

Discuss pregnancy plans with your doctor. Levetiracetam levels in the blood can drop during pregnancy, which might increase the risk of having a seizure. Your doctor will monitor your blood levels and adjust the dose if needed. Levetiracetam is generally considered one of the safer seizure medications during pregnancy, but risks still exist. Pregnant patients should enroll in the North American Antiepileptic Drug Pregnancy Registry. The drug passes into human breast milk. Discuss the risks and benefits of breastfeeding with your doctor.

Tell Your Doctor Before Taking Levetiracetam

• Disclose any history of kidney disease or if you are on dialysis, as your dose will need to be significantly reduced.
• Inform your provider if you have a history of depression, severe mood swings, or suicidal thoughts.
• Share if you have a history of severe allergic reactions to other seizure medications.
• Provide a complete list of all prescription drugs and over-the-counter medicines you take.

Levetiracetam Dosage and Administration

Levetiracetam is available in several forms, including standard tablets, extended-release (XR) tablets, liquid solution for children, and an intravenous (IV) injection used in hospitals.

Standard Levetiracetam Dosing

• Adults (Focal Seizures): The starting dose is usually 500 mg taken twice a day (1000 mg total per day).
• Titration Schedule: Your doctor may increase the dose every 2 weeks by 1000 mg per day until seizures are controlled.
• Maximum Dose: The maximum recommended dose is 3000 mg per day.
• Extended-Release (XR): The XR version is taken just once a day, usually starting at 1000 mg.
• Kidney Impairment: Patients with poor kidney function require lower doses.

How Levetiracetam Is Administered

• Standard tablets and liquid solutions are taken twice a day, usually 12 hours apart.
• Swallow extended-release (XR) tablets whole. Do not chew, break, or crush them.
• You can take this medicine with or without food.
• Use a calibrated measuring syringe for the liquid solution, never a regular household spoon.

Levetiracetam Clinical Efficacy and Research

The FDA approval of Levetiracetam was supported by multiple clinical trials in adults and children with different types of epilepsy. In these studies, patients who added Levetiracetam to their treatment plan experienced a significant reduction in how often they had seizures compared to patients taking a placebo. A large number of patients achieved a 50 percent or greater reduction in seizure frequency, and it proved effective for focal, myoclonic, and generalized tonic-clonic seizures.

Levetiracetam Side Effects and Safety Profile

Levetiracetam is highly effective and safe for the liver, but it carries a well-known risk for causing severe behavioral changes, often referred to by patients as “Keppra rage.”

Common Levetiracetam Side Effects

• Sleepiness (somnolence) and fatigue.
• Weakness (asthenia).
• Dizziness and loss of coordination.
• Irritability and mood changes.
• Infections (like a cold or sore throat).

Serious Levetiracetam Adverse Events

• Psychiatric and Behavioral Symptoms: Severe mood swings, hostility, anxiety, apathy, aggression, psychosis, or hallucinations.
• Suicidal Behavior and Ideation: Like all seizure medications, it increases the risk of suicidal thoughts, behaviors, or extreme worsening of depression.
• Severe Dermatologic Reactions: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) can occur, presenting as unexplained fever, severe skin rash, or mouth sores.
• Anaphylaxis and Angioedema: Severe allergic reactions involving swelling of the face, lips, tongue, or throat.
• Extreme loss of coordination or severe drowsiness.

Managing Levetiracetam Side Effects

If you feel very tired or dizzy, avoid driving until your body adjusts to the medicine. Taking the pill at a consistent time each day can help stabilize side effects. If you or your family notice sudden outbursts of anger, extreme mood swings, suicidal thoughts, or a new skin rash, contact your doctor immediately. The doctor may need to adjust the dose or switch to a different medication.

Levetiracetam Drug Interactions and What to Avoid

Unlike many older seizure drugs, Levetiracetam is not heavily processed by the liver’s enzyme system. This means it has very few interactions with other medications.

Levetiracetam Drug-Drug Interactions

• Central Nervous System Depressants: Combining Levetiracetam with other drugs that make you sleepy (like opioids, anxiety medicines, or sedating antihistamines) will increase drowsiness and dizziness.
• Probenecid: This gout medication can slow down how the kidneys clear Levetiracetam from the body, though it rarely requires a dose change.

Levetiracetam, Food and Alcohol

• You can take Levetiracetam with or without food.
• Avoid drinking alcohol. Alcohol significantly worsens the dizziness, drowsiness, and mood changes caused by the medication.

Levetiracetam Missed Dose, Overdose and Storage

Taking this medicine consistently is critical to keeping a steady amount of drug in your blood to prevent seizures.

Missed Dose of Levetiracetam

If you miss a dose, take it as soon as you remember. If it is almost time for your next scheduled dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time to make up for a missed pill.

Levetiracetam Overdose and Emergency

An overdose of Levetiracetam can cause extreme drowsiness, agitation, aggression, shallow breathing, and coma. If you suspect an overdose, contact a poison control center or seek emergency medical care right away.

How to Store Levetiracetam

• Store tablets and oral liquid at room temperature between 68°F and 77°F (20°C and 25°C).
• Keep the medicine in its original container, protected from light and moisture.
• Keep safely out of reach of children and pets.

Levetiracetam Patient Management and Monitoring

Your healthcare provider will monitor your seizure frequency, mood, and kidney health during regular clinic visits.

Tests Before Starting Levetiracetam

• Baseline kidney function tests (like creatinine clearance) to ensure your kidneys can filter the drug properly.
• A thorough review of your psychiatric history.

Monitoring During Levetiracetam Treatment

• Vigilant monitoring by family members for signs of aggression, severe irritability, or suicidal thoughts.
• Routine checks of kidney function, especially in older adults.
• Tracking how often seizures occur to determine if the dose is working.

Levetiracetam Do’s and Don’ts

• DO take your medication at the same time every day to maintain steady blood levels.
• DO tell your doctor if you experience intense anger or mood swings.
• DON’T stop taking the medicine suddenly; abrupt withdrawal can trigger severe, non-stop seizures (status epilepticus).
• DON’T drive or operate heavy machinery until you know how the medicine affects your alertness.

Frequently Asked Questions

References

• U.S. FDA prescribing information for Keppra (Levetiracetam) tablets and oral solution
• U.S. FDA Drugs@FDA drug approval overview (Application No. 207958)
• American Academy of Neurology Guidelines on Efficacy and Tolerability of the New Antiepileptic Drugs

Legal Disclaimer

The information provided is for educational and informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider at any hospital or any local clinic before starting or stopping any medication.