Levetiracetam
KEPPRA
Pronunciation: lee-ve-tye-RA-se-tam (KEP-ra)
“Levitate Keeper”
Keppra can cause hostility/aggression
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.
Pearls
- Among lowest malformation risks in pregnancy, with lamotrigine.
- IV dose equals oral dose; easy switch.
- Psychosis and hostility more likely with psychiatric history.
- Little cognitive slowing.
Levetiracetam prescription history
Animated chart of estimated U.S. prescriptions per year, Antiseizure meds (1869–2026). Levetiracetam enters in 2000 (estimated).
FDA-approved for
- seizures (1999)
Off-label
- status epilepticus
- post-traumatic seizure prophylaxis
Principal riskIrritability and mood change
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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.
Available strengths
- tab 250, 500, 750, 1000 mg
- sol 100 mg/mL
- inj 5, 10, 15, 100 mg/mL
- ER tab 500, 750 mg
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.
Cost
| Strength | #/mo | generic $ | CostPlus | |
|---|---|---|---|---|
| 250 mg | tab | 60 BID | $3.37/mo | offered |
| 500 mg | tab | 60 BID | $4.42/mo | offered |
| 750 mg | tab | 60 BID | $6.55/mo | offered |
| 1000 mg | tab | 60 BID | $9.58/mo | offered |
| 100 mg/mL | sol | per unit | $0.03/mL | offered |
| 5 mg/mL | inj | per unit | not offered | |
| 10 mg/mL | inj | per unit | not offered | |
| 15 mg/mL | inj | per unit | not offered | |
| 100 mg/mL | inj | per unit | not offered |
Generic entryBy 2023
Open Levetiracetam in the interactive console ↗
Memory aids: interaction avatars
Open Levetiracetam in the interactive console ↗
Self-check
- Which organ impairment requires levetiracetam dose adjustment?
Renal impairment. - Why is levetiracetam useful in polypharmacy?
Minimal hepatic metabolism and interaction burden.