Keppra (levetiracetam) is an antiepileptic drug (AED) indicated for the treatment of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children. As a second-generation medication, it offers a distinct mechanism of action, favorable pharmacokinetic profile, and a well-established safety record. It is widely utilized both as monotherapy and adjunctive therapy in the management of epilepsy, providing neurologists and patients with a reliable option for reducing seizure frequency and improving quality of life. Its predictable metabolism and low interaction potential make it a versatile choice in complex treatment regimens.

Features

• Active ingredient: Levetiracetam
• Available formulations: Film-coated tablets (250 mg, 500 mg, 750 mg, 1000 mg), oral solution (100 mg/mL), and injectable solution (100 mg/mL)
• Mechanism of action: Binds to synaptic vesicle protein 2A (SV2A), modulating neurotransmitter release
• Half-life: Approximately 6–8 hours in adults; 5–6 hours in children
• Bioavailability: Over 95% for oral forms; not affected by food
• Metabolism: Minimally hepatic; primarily hydrolyzed enzymatically; not cytochrome P450 dependent
• Excretion: Primarily renal (66% unchanged)

Benefits

• Demonstrates high efficacy in reducing partial onset seizure frequency with rapid onset of action
• Linear pharmacokinetics allow for predictable dosing and simplified titration
• Low potential for drug interactions due to non-hepatic metabolism
• Generally well-tolerated with a favorable side effect profile compared to older AEDs
• Available in multiple formulations for flexible administration across age groups
• Improves overall seizure control, supporting better daily functioning and quality of life

Common use

Keppra is commonly prescribed for the adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. It is also approved as monotherapy for the treatment of partial onset seizures in adults and adolescents from 16 years of age. Additionally, it is indicated for myoclonic seizures in adults and adolescents 12 years and older with juvenile myoclonic epilepsy, and for primary generalized tonic-clonic seizures in adults and children 6 years and older with idiopathic generalized epilepsy. It may be used off-label in certain cases of neuropathic pain, migraine prophylaxis, and other neurological conditions under specialist supervision.

Dosage and direction

Dosage must be individualized according to the patient’s clinical response, tolerability, renal function, and age. For adjunctive therapy in adults and adolescents (16+ years) with partial onset seizures: initiate with 500 mg twice daily; may increase by 500 mg twice daily every two weeks to a maximum recommended daily dose of 3000 mg. For monotherapy in patients 16 years and older: start with 500 mg twice daily; may increase to 1500 mg twice daily. For oral solution, use the provided dosing syringe. For intravenous administration, it is bioequivalent to oral forms and can be used when oral administration is temporarily not feasible. Dosage adjustment is required in patients with renal impairment. Always follow prescribing information and neurologist recommendations.

Precautions

Patients should be monitored for neuropsychiatric adverse reactions, including agitation, aggression, depression, and suicidal ideation. Caution is advised in patients with a history of psychiatric disorders. Gradual withdrawal is recommended to avoid increased seizure frequency. Renal function should be assessed before and during treatment; dose adjustment is necessary in renally impaired patients. Use during pregnancy only if clearly needed; adequate contraception is advised in women of childbearing potential. Patients should be cautioned regarding activities requiring mental alertness, such as driving or operating machinery, until they know how Keppra affects them.

Contraindications

Keppra is contraindicated in patients with a known hypersensitivity to levetiracetam, other pyrrolidine derivatives, or any excipients in the formulations. There are no other absolute contraindications, but caution is warranted in severe renal impairment without dose adjustment and in patients with a history of severe behavioral or psychotic reactions to the drug.

Possible side effect

Common adverse reactions (≥5%) include somnolence, asthenia, dizziness, and infection. Less frequently, patients may experience:

• Behavioral effects: agitation, anxiety, depression, emotional lability, hostility
• Neurological effects: ataxia, abnormal coordination, headache, tremor
• Gastrointestinal effects: nausea, vomiting, diarrhea, anorexia
• Other: rash, fatigue, nasopharyngitis

Serious but rare side effects may include psychosis, suicidal behavior, pancytopenia, and severe dermatological reactions. Any unusual mood or behavioral changes should be reported immediately.

Drug interaction

Keppra has no clinically significant pharmacokinetic interactions with other antiepileptic drugs such as carbamazepine, valproic acid, phenytoin, phenobarbital, or lamotrigine. It does not affect the pharmacokinetics of oral contraceptives, digoxin, or warfarin. However, potential pharmacodynamic interactions may occur with other CNS depressants (e.g., alcohol, benzodiazepines, opioids), potentially enhancing sedative effects. Caution is advised when co-administering with other drugs that cause dizziness or somnolence.

Missed dose

If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped and the regular dosing schedule resumed. Doubling the dose is not recommended. Patients should be advised to maintain a consistent dosing routine and use reminders if necessary to support adherence.

Overdose

Symptoms of overdose may include drowsiness, agitation, aggression, respiratory depression, and coma. There is no specific antidote. Management includes symptomatic and supportive care, such as ensuring airway patency, monitoring vital signs, and employing general measures to support respiration and circulation. Hemodialysis may be effective in removing levetiracetam from the system; approximately 50% of the drug is removed during a 4-hour session.

Storage

Store at room temperature (15–30°C or 59–86°F). Keep the oral solution in the original bottle; protect from light. Do not freeze. Keep all formulations out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or discontinuing any medication. Individual patient needs and responses may vary. The full prescribing information should be reviewed for complete details on usage, warnings, and precautions.

Reviews

Clinical studies and post-marketing surveillance consistently report Keppra as effective and well-tolerated. Many patients experience significant reductions in seizure frequency with a manageable side effect profile. Neurologists appreciate its predictable pharmacokinetics and low interaction potential, making it suitable for polypharmacy regimens. Some note behavioral side effects as a consideration, particularly in younger patients or those with pre-existing psychiatric conditions. Overall, it remains a widely trusted option in epilepsy management.