Levetiracetam: Uses, Side Effects, Dosage & Epilepsy Treatment Guide

Summary of Key Points

Levetiracetam is a prescription medication primarily used to manage various types of seizures, including epilepsy, partial seizures, and generalized tonic-clonic seizures. It works by stabilizing electrical activity in the brain. Levetiracetam is available in different forms and strengths, and it’s essential to follow your healthcare provider’s instructions carefully. Always consult your healthcare provider before making any changes to your medication. You can also schedule a telemedicine appointment with us for personalized care.

Names of Medication

US Brand Name: Keppra

Generic Name: Levetiracetam

The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer. In this article, the generic name will be shown in parentheses.

Pharmacologic Category

Anticonvulsant

Levetiracetam Dosage

Levetiracetam is used to treat several types of seizures and seizure-related conditions. The dosage and frequency depend on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before adjusting your dose. You can also schedule a telemedicine appointment with us for further guidance.

Epilepsy (Adults): The initial dose is typically 500 mg twice daily. The dose can be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Partial Seizures (Adults): The starting dose is 500 mg twice daily. The dose may be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Myoclonic Seizures (Adults): The initial dose is 500 mg twice daily. The dose can be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Generalized Tonic-Clonic Seizures (Adults): The starting dose is 500 mg twice daily. The dose may be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Lennox-Gastaut Syndrome (Adults): The initial dose is 500 mg twice daily. The dose can be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Status Epilepticus (Adults): The initial dose is 1,000 to 3,000 mg as a single intravenous (IV) dose, followed by maintenance doses as directed by your healthcare provider.

Seizure Disorders (Adults): The starting dose is 500 mg twice daily. The dose may be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Focal Seizures (Adults): The initial dose is 500 mg twice daily. The dose can be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Infantile Spasms (Adults): Dosing is individualized based on the patient’s condition and response to treatment. Consult your healthcare provider for appropriate dosing.

Post-Traumatic Seizures (Adults): The initial dose is 500 mg twice daily. The dose can be increased by 1,000 mg every two weeks, up to a maximum of 3,000 mg per day.

Dosage Forms and Strengths

Levetiracetam is available in the following forms and strengths:

1. Tablets: 250 mg, 500 mg, 750 mg, 1,000 mg
2. Oral Solution: 100 mg/mL
3. Intravenous (IV) Solution: 100 mg/mL

Administration Instructions for Levetiracetam

Levetiracetam can be taken with or without food. Swallow the tablet whole without crushing or chewing it. If using the oral solution, measure the dose carefully with a dosing syringe or cup. For IV administration, this will be done by a healthcare provider. Always follow your healthcare provider’s instructions for dosing and administration. If you miss a dose, take it as soon as you remember, but if it’s close to the time of your next dose, skip the missed dose. Never double up on doses.

Levetiracetam Side Effects

Like all medications, Levetiracetam may cause side effects. Some are common and mild, while others are less common but more serious. If you experience any severe side effects, contact your healthcare provider immediately or seek emergency care.

Common Side Effects

These occur in more than 10% of patients:

1. Drowsiness: Feeling unusually sleepy or fatigued.
2. Dizziness: A sensation of spinning or feeling unsteady.
3. Weakness: Generalized muscle weakness or fatigue.

Less Common Side Effects

These occur in 1-10% of patients:

1. Behavioral changes: Mood swings, irritability, or aggression.
2. Coordination problems: Difficulty with balance or motor skills.
3. Headache: Mild to moderate headaches.

Rare but Serious Side Effects

These occur in less than 1% of patients:

1. Severe allergic reactions: Rash, itching, swelling, or difficulty breathing.
2. Suicidal thoughts: New or worsening depression or thoughts of self-harm.
3. Severe fatigue or weakness: Extreme tiredness that interferes with daily activities.

Contraindications for Levetiracetam

A contraindication is a specific situation or condition where a medication should not be used because it may cause harm to the patient. If you have any of the following conditions, Levetiracetam may not be safe for you to take, and you should discuss this with your healthcare provider.

Hypersensitivity to Levetiracetam: If you have had an allergic reaction to Levetiracetam or any of its ingredients, you should not take this medication. Allergic reactions can include symptoms like rash, itching, swelling, or difficulty breathing.

Severe Kidney Disease: Levetiracetam is cleared from the body by the kidneys. If you have severe kidney disease, your body may not be able to eliminate the drug properly, leading to higher levels in your blood, which can increase the risk of side effects.

Suicidal Thoughts or Behavior: Levetiracetam has been associated with an increased risk of suicidal thoughts or behavior. If you have a history of depression or suicidal ideation, you should discuss this with your healthcare provider before starting the medication.

Levetiracetam Drug Interactions

Levetiracetam can interact with other medications, which may increase the risk of side effects or reduce the effectiveness of either drug. It’s important to inform your healthcare provider about all the medications you are taking, including prescription, over-the-counter, and herbal supplements. Below are some common medications that may interact with Levetiracetam:

Carbamazepine (Tegretol): This anti-seizure medication may reduce the effectiveness of Levetiracetam.

Valproic Acid (Depakote): Taking Valproic Acid with Levetiracetam may increase the risk of side effects like drowsiness or dizziness.

Methotrexate (Trexall): This medication, used for autoimmune diseases and cancer, may increase the levels of Levetiracetam in your blood, leading to a higher risk of side effects.

Antidepressants (e.g., Fluoxetine, Sertraline): Levetiracetam may increase the risk of mood changes or suicidal thoughts when taken with certain antidepressants.

Levetiracetam in Pregnancy

Is it safe to take Levetiracetam during pregnancy?

Levetiracetam is classified as a Category C medication for pregnancy by the FDA. This means that while there are no well-controlled studies in humans, animal studies have shown some risk to the fetus. However, the benefits of controlling seizures during pregnancy may outweigh the potential risks. Uncontrolled seizures can be harmful to both the mother and the baby. If you are pregnant or planning to become pregnant, it’s essential to discuss the risks and benefits of continuing Levetiracetam with your healthcare provider. They may adjust your dosage or recommend additional monitoring throughout your pregnancy.

Levetiracetam while Breastfeeding

Is it safe to take Levetiracetam while breastfeeding?

Levetiracetam does pass into breast milk, but its effects on a nursing infant are not fully understood. Some studies suggest that the levels in breast milk are relatively low and may not pose a significant risk to the baby. However, since the long-term effects are still unknown, it’s important to weigh the benefits of breastfeeding against the potential risks of exposing your baby to the medication. Discuss your options with your healthcare provider to make an informed decision about using Levetiracetam while breastfeeding.

Estimated Cost of Levetiracetam

The cost of a 30-day supply of Levetiracetam without insurance can vary depending on the pharmacy and dosage. With a GoodRx coupon, the estimated cost for a 30-day supply of Levetiracetam (500 mg tablets, taken twice daily) ranges from approximately $15 to $25. Prices may fluctuate, so it’s a good idea to check with your local pharmacy or use a coupon service like GoodRx for the most up-to-date pricing.

Possible Alternatives to Levetiracetam

If Levetiracetam isn’t the right medication for you, there are alternative treatments and lifestyle changes that may help manage your condition. It’s important to discuss these options with your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to explore your options.

Epilepsy Treatment Alternatives

Alternatives to Levetiracetam for epilepsy include other anti-seizure medications such as Lamotrigine (Lamictal) or Valproic Acid (Depakote). Lifestyle modifications, including stress management, getting adequate sleep, and avoiding known seizure triggers, may also help improve seizure control.

Partial Seizures

For partial seizures, medications like Carbamazepine (Tegretol) or Oxcarbazepine (Trileptal) may be considered as alternatives. In some cases, surgery or nerve stimulation therapy may be recommended for better seizure management.

Myoclonic Seizures

Valproic Acid (Depakote) or Clonazepam (Klonopin) are potential alternatives for treating myoclonic seizures. Additionally, dietary changes, such as adopting a ketogenic diet, have been shown to help in some cases.

Generalized Tonic-Clonic Seizures

Alternatives for generalized tonic-clonic seizures include Phenytoin (Dilantin) or Topiramate (Topamax). Regular physical activity and a balanced diet may also contribute to better seizure control.

Lennox-Gastaut Syndrome

Treatment options for Lennox-Gastaut Syndrome include Clobazam (Onfi) or Rufinamide (Banzel). A ketogenic diet or vagus nerve stimulation may also be part of the treatment plan.

Status Epilepticus

Immediate treatment is critical for status epilepticus. Medications like Lorazepam (Ativan) or Diazepam (Valium) are often used. In severe cases, hospitalization may be necessary for more intensive care and monitoring.

Seizure Disorders

Depending on the type of seizure disorder, other medications such as Gabapentin (Neurontin) or Zonisamide (Zonegran) may be considered. Lifestyle changes, including avoiding alcohol and maintaining a regular sleep schedule, can also help manage seizure disorders.

Focal Seizures

Alternatives for focal seizures include medications like Lacosamide (Vimpat) or Eslicarbazepine (Aptiom). Cognitive behavioral therapy (CBT) may also help manage stress, which can be a trigger for seizures.

Infantile Spasms

Treatment options for infantile spasms include ACTH (adrenocorticotropic hormone) or Vigabatrin (Sabril). Early intervention and therapy are crucial for improving developmental outcomes in affected infants.

Post-Traumatic Seizures

For post-traumatic seizures, medications like Phenytoin (Dilantin) or Valproic Acid (Depakote) may be used, depending on the severity. Rehabilitation and physical therapy may also support recovery and help manage seizure activity.

Recent Updates on Levetiracetam Research

Recent studies have focused on the long-term safety and effectiveness of Levetiracetam, particularly in special populations such as children and the elderly. A 2022 study found that Levetiracetam is generally well-tolerated in elderly patients, though dose adjustments may be necessary due to changes in kidney function. Another ongoing study is investigating Levetiracetam’s potential to prevent seizures in patients with traumatic brain injuries. Early results are promising, but further research is needed to confirm these findings.

Additionally, researchers are exploring the use of Levetiracetam in combination with other medications to improve seizure control in patients with drug-resistant epilepsy. These studies are still in the early stages but offer hope for patients who haven’t responded to traditional epilepsy treatments.

It’s important to stay informed about the latest research and discuss any new findings with your healthcare provider. If you have questions about your treatment plan or the use of Levetiracetam, you can schedule a telemedicine appointment with one of our providers to discuss the latest updates and how they may impact your care.

James Kingsley

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