Levetiracetam
KEPPRA
What it isSV2A synaptic-vesicle protein modulator; focal and generalized seizures.
Why this oneMinimal hepatic metabolism and interaction burden make it especially useful in acute illness, cancer treatment and polypharmacy.
What limits itRenal adjustment is essential. Irritability, aggression or depression often ends an otherwise clean trial; ask family as well as the patient.
FDA-approved for
- seizures (1999)
Off-label
- status epilepticus
- post-traumatic seizure prophylaxis
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Partial-onset seizures | Adults ≥16 yr | 500 mg BID | 1500 mg BID | 1500 mg BID (3000 mg/day) |
| Partial-onset seizures | Peds 4–<16 yr | 10 mg/kg BID | 30 mg/kg BID | 30 mg/kg BID |
| Partial-onset seizures | Peds 6 mo–<4 yr | 10 mg/kg BID | 25 mg/kg BID | 25 mg/kg BID |
| Partial-onset seizures | Peds 1–<6 mo | 7 mg/kg BID | 21 mg/kg BID | 21 mg/kg BID |
| Myoclonic seizures (JME) | ≥12 yr | 500 mg BID | 1500 mg BID | 1500 mg BID |
| Primary generalized tonic-clonic seizures | Adults ≥16 yr | 500 mg BID | 1500 mg BID | 1500 mg BID |
| Primary generalized tonic-clonic seizures | Peds 6–<16 yr | 10 mg/kg BID | 30 mg/kg BID | 30 mg/kg BID |
Titration Increase every 2 weeks.
Renal Adjust by CLcr (mL/min/1.73m²): mild 50–80 → 500–1000 mg q12h; moderate 30–50 → 250–750 mg q12h; severe <30 → 250–500 mg q12h; ESRD/dialysis → 500–1000 mg q24h with 250–500 mg supplement post-dialysis.
Hepatic Undefined
Instructions
- Tablets swallowed whole; not chewed or crushed; with or without food.
- Use oral solution for pediatric patients ≤20 kg (weight-based, calibrated device).
- Avoid abrupt withdrawal — taper gradually to reduce risk of increased seizures/status epilepticus.
Contraindications
- Known hypersensitivity to levetiracetam (anaphylaxis, angioedema reported)
Cautions
- Behavioral abnormalities and psychotic symptoms
- Suicidal behavior and ideation
- Somnolence and fatigue — caution driving
- Anaphylaxis/angioedema
- Serious dermatologic reactions (SJS/TEN)
- DRESS/multiorgan hypersensitivity
- Coordination difficulties
- Withdrawal seizures — taper gradually
Adverse reactions
- Adults: somnolence, asthenia, infection, dizziness
- Pediatrics: fatigue, aggression, nasal congestion, decreased appetite, irritability
Pregnancy No drug-associated risk of major defects/miscarriage in humans (registry data); animal developmental toxicity. Plasma levels may fall in pregnancy — monitor.
Lactation Excreted in human milk; no data on effects on breastfed infant.
NO BOXED WARNINGS
Principal riskIrritability and mood change
Cost, est. cash$10–$500/month
Generic entryBy 2023
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
Mechanism of action: Levetiracetam ballicule
Open Levetiracetam in the interactive console ↗
Memory aids: mascots and interaction avatars
Keppra can cause hostility/aggression
