What are the primary uses of Keppra. How should Keppra be administered. What are the potential side effects of Keppra. How does Keppra interact with other medications. Can Keppra be used during pregnancy. What precautions should be taken when using Keppra long-term. How can patients optimize their Keppra treatment.

Understanding Keppra: An Overview of the Anticonvulsant Medication

Keppra, known generically as levetiracetam, is a powerful anticonvulsant medication used primarily in the treatment of epilepsy. It belongs to a class of drugs called anticonvulsants, which work by regulating brain chemicals to control nerve signals and prevent seizures. Keppra has gained widespread use due to its efficacy in managing various types of seizures, including partial-onset seizures, tonic-clonic seizures, and myoclonic seizures associated with juvenile myoclonic epilepsy.

Is Keppra effective as a standalone treatment? While Keppra can be prescribed as monotherapy in some cases, it is often used in combination with other antiepileptic medications to provide comprehensive seizure control. This versatility makes it a valuable tool in the management of epilepsy for both adults and children over the age of six.

Keppra’s Mechanism of Action: How Does It Control Seizures?

To understand how Keppra works, it’s essential to delve into its mechanism of action. Unlike many other anticonvulsants, Keppra has a unique way of interacting with the brain to prevent seizures. It binds to a specific protein in synaptic vesicles, known as SV2A, which is involved in the release of neurotransmitters.

How does this binding affect seizure activity? By modulating the SV2A protein, Keppra helps to stabilize electrical activity in the brain. This stabilization reduces the likelihood of abnormal electrical discharges that can lead to seizures. Additionally, Keppra may influence other neurotransmitter systems, contributing to its broad spectrum of efficacy against different seizure types.

Key Points About Keppra’s Mechanism:

• Binds to SV2A protein in synaptic vesicles
• Stabilizes electrical activity in the brain
• May influence multiple neurotransmitter systems
• Provides broad-spectrum seizure control

Navigating Keppra Dosage: Finding the Right Balance

Determining the appropriate dosage of Keppra is crucial for achieving optimal seizure control while minimizing side effects. Dosage requirements can vary significantly based on factors such as the patient’s age, weight, specific type of seizures, and overall health status.

How is Keppra typically administered? Keppra is available in several forms, including immediate-release tablets, extended-release tablets, oral solution, and injection solution. For most patients, the medication is taken orally twice daily, with or without food. The extended-release formulation allows for once-daily dosing, which can improve compliance for some patients.

Standard Dosing Guidelines:

1. Adults with partial-onset seizures: Starting dose of 1000 mg/day, increased gradually to 3000 mg/day
2. Children (4-16 years) with partial-onset seizures: 20-60 mg/kg/day, divided into two doses
3. Adults with myoclonic seizures: Starting dose of 1000 mg/day, increased to 3000 mg/day
4. Adults and children with primary generalized tonic-clonic seizures: Similar to partial-onset seizure dosing

Can the dosage be adjusted over time? Yes, your healthcare provider may start with a lower dose and gradually increase it to find the most effective level for seizure control. It’s crucial to follow your doctor’s instructions carefully and not adjust the dosage without medical supervision.

Recognizing and Managing Keppra Side Effects

While Keppra is generally well-tolerated, like all medications, it can cause side effects. Understanding these potential adverse reactions is essential for patients and caregivers to ensure prompt recognition and management.

What are the most common side effects of Keppra? The most frequently reported side effects include:

• Drowsiness or fatigue
• Dizziness
• Weakness
• Headache
• Nausea
• Irritability

Are there any serious side effects to be aware of? While less common, some patients may experience more severe reactions, such as:

• Mood changes or behavioral problems
• Depression or suicidal thoughts
• Coordination difficulties
• Allergic reactions (rare)

How can patients manage these side effects? Many side effects are temporary and may subside as the body adjusts to the medication. However, it’s crucial to communicate any persistent or concerning symptoms to your healthcare provider. They may adjust the dosage or suggest strategies to mitigate side effects while maintaining seizure control.

Long-term Use of Keppra: Considerations and Monitoring

For many patients with epilepsy, Keppra becomes a long-term treatment option. Understanding the implications of extended use is crucial for both patients and healthcare providers.

Does long-term use of Keppra pose any specific risks? While Keppra is generally considered safe for long-term use, ongoing monitoring is essential. Some considerations for long-term use include:

• Potential impact on bone density
• Monitoring of kidney function, especially in older adults
• Vigilance for mood changes or behavioral issues
• Regular blood tests to check for any alterations in liver function or blood cell counts

How often should patients on long-term Keppra therapy be evaluated? Regular follow-up appointments are typically recommended, with the frequency determined by individual patient needs. These appointments may include:

• Assessment of seizure control and medication efficacy
• Evaluation of side effects and quality of life
• Blood tests to monitor drug levels and overall health
• Adjustments to dosage or treatment plan as needed

Keppra Interactions: Navigating Combination Therapies

Understanding how Keppra interacts with other medications is crucial for ensuring safe and effective treatment, especially given that many epilepsy patients require multiple medications for optimal seizure control.

Does Keppra have significant interactions with other drugs? Compared to many other antiepileptic drugs, Keppra has a relatively favorable interaction profile. However, there are still some important considerations:

• Interactions with other antiepileptic drugs: While generally minimal, some adjustments may be necessary when combining Keppra with drugs like carbamazepine or valproic acid.
• Alcohol and CNS depressants: These can enhance the sedative effects of Keppra.
• Methotrexate: Keppra may decrease the clearance of methotrexate, potentially increasing its toxicity.
• Probenecid: This medication can affect how the kidneys process Keppra, potentially altering its levels in the body.

How can patients ensure safe medication management? Open communication with healthcare providers is key. Patients should:

• Provide a complete list of all medications, including over-the-counter drugs and supplements
• Inform all healthcare providers about their Keppra use
• Avoid starting or stopping any medications without consulting their doctor
• Be aware of potential signs of drug interactions and report any unusual symptoms promptly

Keppra and Special Populations: Pregnancy, Elderly, and Pediatric Considerations

The use of Keppra in special populations requires careful consideration and tailored approaches to ensure safety and efficacy.

Can Keppra be used during pregnancy? The use of Keppra during pregnancy is a complex decision that must balance the risks of uncontrolled seizures against potential risks to the fetus. While Keppra is considered one of the safer antiepileptic options during pregnancy, it’s not without risks. Key points include:

• Potential increased risk of minor congenital malformations
• Possible effects on fetal growth and development
• Need for close monitoring and potential dosage adjustments during pregnancy
• Importance of folic acid supplementation

How is Keppra used in elderly patients? Elderly patients may require special considerations due to potential changes in kidney function and increased sensitivity to side effects. Dosage adjustments and closer monitoring may be necessary.

Is Keppra safe for use in children? Keppra is approved for use in children 4 years and older for certain types of seizures. Pediatric dosing is typically weight-based, and careful monitoring for behavioral side effects is important.

Optimizing Keppra Treatment: Tips for Patients and Caregivers

Maximizing the benefits of Keppra while minimizing potential drawbacks requires active patient involvement and informed decision-making.

How can patients ensure they’re getting the most out of their Keppra treatment? Consider the following tips:

• Maintain a consistent schedule: Take Keppra at the same times each day to maintain steady blood levels.
• Stay hydrated: Adequate hydration can help minimize some side effects and support overall health.
• Monitor and record seizures: Keep a seizure diary to track frequency, duration, and potential triggers.
• Be aware of potential drug interactions: Inform all healthcare providers about Keppra use and other medications.
• Prepare for travel: Ensure you have enough medication and consider time zone changes for dosing schedules.
• Engage in healthy lifestyle practices: Regular sleep, stress management, and avoiding known seizure triggers can complement medication effectiveness.

What should patients do if they miss a dose? If a dose is missed, it should be taken as soon as remembered, unless it’s close to the time for the next dose. In that case, skip the missed dose and resume the regular schedule. Never double up on doses to make up for a missed one.

By following these guidelines and maintaining open communication with healthcare providers, patients can optimize their Keppra treatment and improve their overall quality of life while managing epilepsy effectively.

HealthMatch – Keppra (Levetiracetam)

Content

• What is Keppra?
• What does Keppra treat?
• How do you take Keppra?
• Potential side effects of Keppra
• Long-term use of Keppra
• Missed doses
• Overdoses
• What to discuss with your doctor before you start taking Keppra
• Stopping Keppra
• Keppra and pregnancy
• Interactions with other drugs
• Allergy information
• Clinical trial history
• Tips and advice for taking Keppra

Curious about clinical trials?

Access the latest treatments and medications. unavailable elsewhere – entirely free of charge. We make it easy to take part.

Check your eligibility

Keppra belongs to a class of drugs called anticonvulsants. Keppra is a prescription medication for treating the symptoms of partial-onset seizures, tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy. Keppra may be taken alone or with other medicines.

The generic version of Keppra is levetiracetam.

Keppra is an anti-seizure medication that treats the symptoms associated with myoclonic seizures and as adjunctive therapy for partial-onset seizures.

Doctors can also combine Keppra (levetiracetam) with other drugs to treat primary generalized tonic-clonic seizures (seizure that involves the entire body) in patients with epilepsy, both adults and children over six.

These medications regulate brain chemicals that control nerve signals so that seizures don’t occur. Keppra may either be taken alone or in combination to treat your condition. You may be prescribed Keppra in addition to your current therapy.

Myoclonic seizures

Myoclonic seizures of juvenile myoclonic epilepsy are seizures that involve the neck, shoulders, and upper arms. Many patients experience their seizures within minutes of waking up.

They usually begin between adolescence and early adulthood. Most people who have epilepsy can control their seizures with medication, but they must continue taking it throughout life.

Partial-onset seizure

Abnormal electrical activity within your brain causes partial-onset seizures. During a seizure, people may experience a variety of different symptoms. Common symptoms of partial-onset seizures include losing consciousness, becoming unconscious, experiencing uncontrolled muscle movements, and experiencing altered sensory perceptions.

Tonic-clonic seizures

A tonic-clonic seizure is usually what most people think of whenever they hear the word “convulsion.” Tonic-clonic seizures combine the characteristics of both tonic and clonic convulsions. Tonic means stiffening, and clonic means jerking.

Ask your doctor if you have any questions about why they prescribed Keppra for you.

Keppra is not yet FDA-approved for children younger than four years old.

Keppra is available in several forms:

• Tablets (immediate release): 250mg, 500mg, 750mg, and 1000mg. 

• Tablets (extended release): 500mg and 750mg.

• Liquid solution: 100mg/ml.  

• Injection solution: 5mg/ml, 10mg/ml, 15mg/ml, and 100 mg/ml.

Read the Patient Information Leaflet provided by your pharmacist before starting levetiracetam. If you have any further concerns or questions, ask your healthcare provider.

Take the medication as directed by your doctor, twice daily with or without meals.

Liquid form

If you’re using the liquid form of the medicine, carefully measure the dose by using a medical measuring device. For example, use the measuring cup that comes with the medication instead of a household spoon. Using the right tool means you’ll get the correct amount and avoid any symptoms reappearing.

Tablet form

Take this drug as instructed by your healthcare provider, usually once daily.

Do not break or chew Keppra pills. This can create a bitter taste and affect how your body processes the medicine. This can increase the risks of side effects. Don’t split tablets if they don’t have a score line unless your doctor or pharmacist tells you to.

Your doctor bases the dose on your medical condition and how your body responds to treatment. The dosage in children depends on their weight. To lessen the chances of side effects, your doctor may suggest starting this medication at a low dosage and gradually increasing your dosage. Follow their directions carefully.

For liquid injection

The dose is 100mg per 1mL (milliliters). In 2006, the FDA approved Keppra as an alternative for patients with seizures who cannot take their medicine orally.

It must be diluted before use according to the package insert and administered as a 15-minute intravenous (IV) infusion.

Daily dose for juvenile myoclonic epilepsy

Your doctor will start treatment with a dose of 1000mg per day (500mg twice daily) for the first week. Increase the dosage by 1000mg per day every two weeks to the recommended daily dosage of 3000mg. Researchers have not studied the effectiveness of doses below 3000mg per day.

Daily dosage for primary generalized tonic-clonic seizures

For adolescents and adults aged 16 years and older

Your doctor will start treatment with a dose of 1000mg per day (as 500mg twice daily) for the first week. Increase the dosage by 1000mg per day every two weeks to the recommended daily dosage of 3000mg. Researchers have not studied the effectiveness of doses above 3000mg per day.

For pediatric patients aged 6 to 16 years

Your doctor will start treatment with a daily dose between 20 and 30mg/kg in two equally divided doses. Increase the daily dose of the medication every two weeks by increments of 10mg/kg (5mg/kg twice daily) until the recommended daily dose of 30mg/kg (15mg/kg twice daily is reached). There are no adequate studies on the effectiveness of doses lower than 30mg/kg per day.

Daily dosage for partial-onset seizures

For adolescents and adults aged 16 years and older

Your doctor will start treatment with a dose of 1000mg per day (as 500mg twice daily) for the first week. Your doctor may give additional doses up to 1000mg per day to the maximum recommended daily dosage of 3000mg. Researchers have not studied the effectiveness of doses below 3000mg per day.

For pediatric patients from 1-6 months

Your doctor will start treatment at a dose of 7mg/kg twice daily. Increase the daily dose by increments every two weeks until you reach the recommended daily dose (21mg/kg twice daily).

For pediatric patients aged six months to under four years

Your doctor will start treatment with a daily dose equal to 20mg/kg divided into two 10mg/kg doses twice daily. They will increase the daily dose by 20mg/kg every two weeks until reaching the recommended daily dose of 50mg/kg (25mg/kg twice daily). If your child cannot tolerate 25mg/kg, your doctor may reduce the daily dosage.

Take this medication regularly to get the maximum benefit from it. To help you remember better, take it at the same time every day.

You may need to give your child levetiracetam (Keppra) for several weeks before you see a decrease in seizures. If there is no decrease after two weeks, contact your healthcare provider.

Do not increase your dosage or use this drug more frequently than prescribed. Your condition will not improve any faster, and your chances of experiencing side effects of levetiracetam will increase.

These potential reactions are most likely to occur during the first four weeks of treatment. They may lessen as your body adjusts. Tell your doctor if any side effects persist or become bothersome.

Common side effects include:

Remember, your doctor has prescribed Keppra as they have determined that the benefits outweigh the risks. Many people taking this drug do not have severe reactions.

Talk to your healthcare provider right away if you have any severe side effects, such as:

• Sore throat that doesn’t go away

• Fever or chills

• Difficulty walking and controlling muscles

• Mood changes

• Panic attack, agitation, restlessness, or nervousness

• Signs of anemia

• Easy bruising/bleeding

• Loss of balance

A few patients taking anticonvulsant medications for any condition (such as seizures, bipolar disorder, pain) may develop depression, suicidal thoughts/attempts, or other mental health issues.

Tell your doctor immediately if you, your family, or your caregiver notice any of these symptoms:

• Unusual or sudden changes in your mood, thinking, or behavior

• Signs of depression

• Suicidal thoughts

• Thoughts about harming yourself

Levetiracetam may cause a rash, which is usually not serious. However, you may be unable to tell whether it’s a rash indicating an allergic reaction. If you develop any rashes, tell your doctor right away.

Get immediate medical attention if you experience any symptoms of a severe allergic reaction:

If you experience any other side effects, let your doctor know.

As Keppra is a relatively new medicine, no studies have shown lasting harmful effects if you take it over many months or years.

There is no evidence to suggest that Keppra is addictive.

It’s important to take this medicine regularly. If you miss doses, you may experience a seizure.

If you forget to take your medicine, take it as soon as you remember and then return to taking it as normal. If it’s less than 8 hours before your next dose, skip the missed dose and take it at your usual time.

Don’t take an extra dose to compensate for a forgotten one.

If you forget doses, it may be helpful to set an alarm to remind you. You could also ask the pharmacist for advice on ways to help you remember to take your medicine.

Taking too much Keppra can result in severe side effects, and it can be dangerous.

Symptoms of a Keppra overdose include the following:

Call 911 or go to your nearest emergency room if you or someone you care for overdoses on Keppra.

• Any allergies you may have to levetiracetam (Keppra), any other medications, and any other allergies

• Any prescription and nonprescription drugs, vitamins, nutritional supplements, and herbal products you take or plan to take. You may need to adjust the doses of your medications.

• Tell your doctor if you have any of these conditions: Kidney disease, depression, low moods, or suicidal thoughts.

• If you’re pregnant, planning to get pregnant, or breastfeeding. Contact your doctor immediately if you become pregnant while taking Keppra.

Limited research suggests children should be seizure-free for two years and adults for two to five years before they consider stopping the medication. It’s hard to know whether you’ve been seizure-free because your medicine is working or your epilepsy has gone away.

Changing your medication may be better for your health than taking the same one. There are over 20 epilepsy medications available, so you can work with your doctor to find the right one for you.

What you should expect

More than half of patients who stop taking their epilepsy medications remain seizure-free for at least one year. However, the chances of relapse can still be as high as 25%, even among people with the most optimistic outlooks for stopping treatment.

The likelihood of having a seizure during the first two years after stopping medication is doubled compared to when you were on the medications. After that, there isn’t any difference.

If seizures return, there’s a good chance they can be well-controlled with medication again, but you may not immediately see results. For some people, this may take up to two years.

As there’s no way to be sure whether seizures will recur, you must work closely with your doctor before and after deciding to stop taking medication.

Levetiracetam is pregnancy category C. The FDA advises caution, but the potential benefits of the medication (that is not having a seizure) may outweigh any potential risks.

Animal studies suggest that levetiracetam may be harmful to the developing fetus. If you are pregnant or plan to get pregnant, talk to your doctor.

The risk of congenital disability is generally higher in children whose mothers take more than one seizure medication at the same time and have a family history of having a child born with a congenital disability. Therefore being on a single agent at the lowest possible dose may be recommended.

Risks during pregnancy

Some women may experience more seizures during pregnancy due to hormonal changes and how their bodies handle seizure medication. In the case of Levetiracetam, levels gradually decrease during pregnancy and thus the dosage needs to be closely monitored by a doctor.

Talk to your doctor before becoming pregnant about seizures and if any medicines need to change. They will tell you when they need to check your blood levels of medication during pregnancy. During and after pregnancy, the dose of seizure medicine may have to be adjusted.

Breastfeeding

Low drug levels have been found in breastmilk when nursing mothers have taken average doses of levetiracetam. It’s unlikely to cause any problems for a baby. However, levetiracetam could affect a woman’s ability to produce breast milk.

If you choose to breastfeed while taking anticonvulsants, check your baby for drowsiness and keep track of their growth and development if you’re taking more than one seizure medication.

Talk to your healthcare team about any concerns that may arise with breastfeeding.

You should never take certain medications together. In some cases, though, you may need to take two medicines together even if there could be an adverse effect or unwanted drug interaction. If your doctor wants to change the dose, they may need additional precautions.

Your healthcare provider must know if you are taking any other medications when taking levetiracetam. The following interactions have all been selected based on their potential significance and are by no means all-inclusive.

These medications are usually not recommended for combination, but your doctor may deem it necessary:

• Calcifediol

• Methotrexate

• Orlistat

If you use this drug with any of these medicines, there may be an increased risk of severe specific side effects. However, using both drugs may be better than either one alone. Your doctor may adjust the dose or frequency of your medicines if you’re taking them together.

• Carbamazepine

• Ginkgo

Other interactions

Drinking alcohol with this drug may increase the risk of unwanted side effects. It can also increase seizure risk.

Other medical problems

Other medical conditions may affect the use of these medicines. Make sure you tell your doctor if you have any additional health issues, especially:

People allergic to Keppra and its ingredients should not use this medication. Check the product label for a list of ingredients, and tell your doctor about any allergies.

Allergic reaction symptoms include: 

• Hives/rash

• Restricted breathing

• Difficulty swallowing

• Swelling (especially in the face and throat)

Discuss your allergies with your doctor so they can adjust your prescription accordingly.

Some seizure medications don’t work for everyone. Your doctor may try a series of medicines or a combination to find one that’s most effective for you.

• Most studies¹ showed that approximately 20 to 40% of patients experienced at least a 50% reduction in their seizures when taking levetiracetam with other seizure medications.

• One study¹ found that levetiracetam may be helpful when taken alone in people with focal (partial) seizures.

• After trying a dose for at least two weeks, your doctor may increase or decrease the amount depending on whether it’s working well enough for you.

• A child who weighs at least 20 kilograms (44 pounds) should take the tablet form of Keppra.

• Don’t crush, chop, or chew the pill, as this can increase side effects.

• If you or your children are having trouble swallowing the tablets whole, ask your healthcare professional if you can switch to an oral solution (liquid) form.

• Take the oral solution as prescribed and use the provided measuring cup.

• If you observe any changes in your mood or thoughts, or if your child is acting strangely after taking Keppra, tell your doctor. Call 911 or go to the nearest hospital if you’re thinking of hurting yourself.

• Keppra may cause drowsiness, fatigue, weakness, or difficulty in movement and coordination. Don’t drive, operate machinery, or do anything that requires concentration until you know how it affects you.

• Talk to your doctor before stopping Keppra. Stopping it too abruptly can cause seizures due to withdrawals.

A case of levetiracetam (Keppra) poisoning with clinical and toxicokinetic data

Case Reports

. 2002;40(7):881-4.

doi: 10.1081/clt-120016959.

F Barrueto Jr 
¹
, K Williams, M A Howland, R S Hoffman, L S Nelson

Affiliations

Affiliation

• ¹ Department of Emergency Medicine, New York University School of Medicine and the New York City Poison Control Center, New York, New York, USA. [email protected]

• PMID:

  12507057

• DOI:

  10.1081/clt-120016959

Case Reports

F Barrueto Jr et al.

J Toxicol Clin Toxicol.

2002.

. 2002;40(7):881-4.

doi: 10.1081/clt-120016959.

Authors

F Barrueto Jr 
¹
, K Williams, M A Howland, R S Hoffman, L S Nelson

Affiliation

• ¹ Department of Emergency Medicine, New York University School of Medicine and the New York City Poison Control Center, New York, New York, USA. [email protected]

• PMID:

  12507057

• DOI:

  10.1081/clt-120016959

Abstract

Background:

Levetiracetam (Keppra) is a new anticonvulsant used to treat partial complex seizures that is also being investigated for its mood-stabilizing properties. Although its precise mechanism of action is unknown, levetiracetam does not appear to directly interact with the GABA system. We report the first intentional overdose with levetiracetam including clinical effects and serial serum concentrations.

Case report:

A 38-year-old woman reportedly ingested 60 (500 mg) tablets of levetiracetam that she used as a mood-stabilizing medication for bipolar disorder. She had no other prescription medications available and no other medical history. She vomited 4 hours after ingestion and presented to the ED 2 hours later. In the ED, the patient was obtunded and was intubated secondary to respiratory depression. Her only other significant clinical finding was diminished deep tendon reflexes. Serum ethanol, lithium, carbamazepine, phenytoin, and valproic acid levels were all negative as was a subsequent urine screen for drugs of abuse. Her levetiracetam serum concentration was 400 microg/mL at 6 hours, 72 microg/mL at 18 hours, and 60 microg/mL at 20.5 hours (therapeutic serum concentration is 10-37 microg/mL). The elimination half-life was calculated to be 5.14 hours. She was extubated the next hospital day and recovered without sequelae.

Conclusion:

In overdose, levetiracetam is sedating and causes respiratory depression, however, recovery is rapid with supportive care. This is the first reported case of levetiracetam overdose; serial serum concentrations suggest first-order elimination even at concentrations 10-40 fold higher than therapeutic.

Similar articles

• Overdose with levetiracetam: a case report and review of the literature.

  Larkin TM, Cohen-Oram AN, Catalano G, Catalano MC.

  Larkin TM, et al.
  J Clin Pharm Ther. 2013 Feb;38(1):68-70. doi: 10.1111/j.1365-2710.2012.01361.x. Epub 2012 Jun 21.
  J Clin Pharm Ther. 2013.

  PMID: 22725831

  Review.

• Cardiac sodium channel blockade after an intentional ingestion of lacosamide, cyclobenzaprine, and levetiracetam: Case report.

  Chua-Tuan JL, Cao D, Iwanicki JL, Hoyte CO.

  Chua-Tuan JL, et al.
  Clin Toxicol (Phila). 2015 Jul;53(6):565-8. doi: 10.3109/15563650.2015.1040157. Epub 2015 May 8.
  Clin Toxicol (Phila). 2015.

  PMID: 25951877

• Levetiracetam and topiramate poisoning: Two overdoses on those drugs with no lasting effects.

  Sarfaraz M, Syeda RH.

  Sarfaraz M, et al.
  Drug Discov Ther. 2017 May 30;11(2):115-117. doi: 10.5582/ddt.2016.01082. Epub 2017 Mar 19.
  Drug Discov Ther. 2017.

  PMID: 28320983

• Postmortem levetiracetam (Keppra®) data from North Carolina.

  Bishop-Freeman SC, Kornegay NC, Winecker RE.

  Bishop-Freeman SC, et al.
  J Anal Toxicol. 2012 Jul;36(6):422-8. doi: 10.1093/jat/bks052. Epub 2012 May 25.
  J Anal Toxicol. 2012.

  PMID: 22635608

• An 11-year review of levetiracetam ingestions in children less than 6 years of age.

  Lewis JC, Albertson TE, Walsh MJ.

  Lewis JC, et al.
  Clin Toxicol (Phila). 2014 Nov;52(9):964-8. doi: 10.3109/15563650.2014.965828. Epub 2014 Oct 6.
  Clin Toxicol (Phila). 2014.

  PMID: 25283254

  Review.

See all similar articles

Cited by

• Multifocal myoclonus as a presentation of levetiracetam toxicity.

  Bou Nasif M, Varade S, Koubeissi MZ.

  Bou Nasif M, et al.
  Clin Neurophysiol Pract. 2021 Nov 7;6:281-284. doi: 10.1016/j.cnp.2021.10.004. eCollection 2021.
  Clin Neurophysiol Pract. 2021.

  PMID: 34877439
  Free PMC article.

• Data on the relationship between lamotrigine and levetiracetam serum/plasma levels and toxicity: Experience at an academic medical center.

  Wood KE, Palmer KL, Krasowski MD.

  Wood KE, et al.
  Data Brief. 2021 Nov 8;39:107555. doi: 10.1016/j.dib.2021.107555. eCollection 2021 Dec.
  Data Brief. 2021.

  PMID: 34825027
  Free PMC article.

• Clinical outcomes in newer anticonvulsant overdose: a poison center observational study.

  Wills B, Reynolds P, Chu E, Murphy C, Cumpston K, Stromberg P, Rose R.

  Wills B, et al.
  J Med Toxicol. 2014 Sep;10(3):254-60. doi: 10.1007/s13181-014-0384-5.
  J Med Toxicol. 2014.

  PMID: 24515527
  Free PMC article.

• Suicidality in people taking antiepileptic drugs: What is the evidence?

  Bell GS, Mula M, Sander JW.

  Bell GS, et al.
  CNS Drugs. 2009;23(4):281-92. doi: 10.2165/00023210-200923040-00002.
  CNS Drugs. 2009.

  PMID: 19374458

• Potential of levetiracetam in mood disorders: a preliminary review.

  Muralidharan A, Bhagwagar Z.

  Muralidharan A, et al.
  CNS Drugs. 2006;20(12):969-79. doi: 10.2165/00023210-200620120-00002.
  CNS Drugs. 2006.

  PMID: 17140277

  Review.

See all “Cited by” articles

Publication types

MeSH terms

Substances

Keppra instructions for use, price: Side effects, active substance

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS REQUIRED.

Author of the article

Podoinitsyna Alena Andreevna,

Diploma in pharmaceutical education: 105924 3510722 reg. number 31917

All authors

Article content

• Keppra: active ingredient
• Keppra: dosage
• Keppra: side effects
• Executive summary
• Ask an expert about the topic

Epilepsy is a common neurological disease affecting more than 50 million people worldwide. It is a chronic brain disease that occurs due to excessive electrical activity of cells in various parts of the brain. Develops at any age. Accompanied by recurrent convulsive seizures and loss of consciousness. The forms of seizures are very different: from minor memory lapses, muscle spasms to severe, prolonged convulsions.

WHO estimates that 70% of people with epilepsy can live without seizures if they are provided with timely diagnosis and treatment. The disease is treated with medical and surgical methods. Since epilepsy has more than 50 forms with different development mechanisms, drugs that act on different receptors in the brain are needed.

The pharmacist talks about the antiepileptic drug Keppra: what active ingredient it contains, what dosage forms and dosages it has, what side effects can be.

Keppra: active substance

For Keppra INN (international non-proprietary name) – levetiracetam. The action of the active substance is associated with several channels for the transmission of impulses by neurons in the brain, but the mechanism itself is not yet fully understood.

Levetiracetam has been shown to have an anticonvulsant effect in both partial (short-term involuntary seizures in any part of the body) and generalized seizures (convulsions throughout the body).

Keppra is used for the treatment of epilepsy in adults and children:

• as monotherapy in case of newly diagnosed epilepsy (from 16 years of age)
• in the complex therapy of partial seizures (in children from 1 month old)
• for convulsions and convulsive seizures in patients with myoclonic juvenile and idiopathic generalized epilepsy (from 12 years old)

All Keppra products 20 reviews x and dosages:

• Keppra 250 mg film-coated tablets (blue)
• Keppra 500 mg film-coated tablets (yellow)
• Keppra 1000 mg film-coated tablets (white)
• Keppra concentrate for infusion in vials 100 mg/ml 5 ml
• Keppra oral solution, 100 mg/ml 300 ml

The daily dose of Keppra is divided in half into two doses. The maximum daily dosage for adults is 3000 mg, the average is 1000 mg. Depending on the clinical picture and tolerability of the drug, the doctor may reduce or increase the dose (250-500 mg twice a day) every 2-4 weeks.

For children older than 1 month and adolescents under 17 years of age weighing less than 50 kg, the appropriate dosage form and dosage is selected by the doctor. It takes into account the child’s body weight, age and required therapeutic dose.

Children’s dosages over the age of 1 month and up to six months are 14-42 mg / kg, over 6 months – 20-60 mg / kg per day, also divided into two doses. In any form of epilepsy, it is necessary to prescribe the minimum effective dose. For infants, a dosage form is used in the form of a solution for oral administration. The solution is dosed using the measuring syringes included in the package. Keppra solution can be diluted in water and given from a bottle.

The dosage form of Keppra tablets is indicated for adults and children over 6 years of age.

Solution for infusion is used after 4 years as a temporary alternative when oral administration of Keppra is not possible.

Keppra: side effects

Based on clinical and post-marketing studies, the most common side effects of the drug were identified:

• nasopharyngitis
• drowsiness
• headache, dizziness
• fatigue

In addition to these, side effects often appear, such as:

• anorexia
• depression, anxiety
• hostility and aggressiveness
• insomnia
• nervousness, irritability
• convulsions, imbalance, tremor, lethargy, vertigo
• cough
• abdominal pain, dyspepsia, diarrhea
• nausea, vomiting
• rash
• fatigue

In children, the manifestations and frequency of adverse reactions are comparable to those in adult patients.

Summary

• INN of the active substance of Keppra – levetiracetam. This is a substance with anticonvulsant and antiepileptic action, effective in most epileptic syndromes.
• Only a doctor can prescribe a drug and adjust the dosage. For children older than a month and up to 6 years old, Keppra solution is used for oral administration, for children over 6 years old and adults, Keppra tablets are used. Solution for infusion is used in cases where the patient is unable to take oral medications.
• Very common side effects of Keppra: headache, dizziness, drowsiness, fatigue, nasopharyngitis.

Ask an expert about the topic of the article

Still have questions? Ask them in the comments below and our experts will answer you. There you can also share your experience with other Megatips readers.

Editor-in-chief

Zotina Natalya Igorevna,

Expert pharmacist

Share the mega-advice

Like the article? Tell mom, dad, grandma and aunt Galya from the third entrance

Copy link

Side effects of antiepileptic drugs (Table)

Side effects of antiepileptic drugs and how to deal with them. See the answer of an expert epileptologist. Dr. Ilan Blat, Migdal Medical Clinic (Israel).

Drug therapy is currently the main effective treatment for epilepsy. With the right drugs, you can achieve complete control over seizures and even completely cure the patient of epilepsy. Despite this, a certain group of patients may experience unwanted side effects while taking antiepileptic drugs.

“Doctor, my child started complaining of nausea and constant fatigue…”
“I am starting to get better… Is this a side effect of Depakine?”
“How to deal with the side effects of antiepileptic drugs?”

Modern medicine is armed with about 20 main antiepileptic drugs (AEP) with different active ingredients. One of the main differences between them is the possible side effects that may occur during the treatment process.

Emphasis on the word “possible” is important, since anticonvulsants do not necessarily cause side effects. Many patients do not feel any negative effects of drugs even after years of use.

Parents who are in doubt whether or not to start treatment because of the possible occurrence of side effects should think and weigh what scares them more: possible side effects or epilepsy with its manifestations.

As for adult patients with epilepsy, they have already seen from their own experience how important it is to keep seizures under control, and therefore they are not afraid of side effects from taking drugs, since at any time the drug can be replaced with another one, which, in most cases, , will not cause side effects.

In general, the side effects of AEDs appear at the very beginning of therapy or after making any changes to the treatment protocol, for example, after increasing the dosage of the drug or due to the addition of a new drug.

At this time, it is especially important to be under the supervision of the attending epileptologist, and to make timely adjustments to the treatment protocol.

For more information about how drugs are selected, how to take them and when to stop taking them, read the article Antiepileptic drugs. What should you know about them?

Possible side effects of antiepileptic drugs – list of drugs Possible side effects Benzodiazepines Klonopin nervousness, drowsiness Brivaracetam Briviact fatigue, dizziness, nausea Valproic acid Depakine, Depakene, Stavzor weight gain, tremor, hair loss and brittleness, menstrual disorders, polycystic ovary syndrome, pancreatitis (rare), thrombocytopenia Vigabatrin Sabril reduction concentration, loss of visual field (with long-term use and dose dependence in 40% of cases) Gabapentin Neurontin, Gralise,
Gabarone,
Fanatrex dizziness, nausea, drowsiness / hyperactivity, aggression, peripheral edema, weight gain Carbamazepine Tegretol, Carbatrol,
Epitol fatigue, concentration problems, hyponatremia Clonazepam Klonopin hyperactivity in children, drowsiness, behavioral disorders, decreased concentration, visual disturbances, tremor, dizziness, irritability Lacosamide Vimpat dizziness, headache, nausea, fatigue, weight loss Lamotrigine Lamictal, Subvenite headache, trouble sleeping. Rare: allergic reaction, risk of Stevens-Jones syndrome Levetiracetam Keppra, Roweepra,
Elepsia drowsiness, nervousness/depression to psychotic state Oxcarbazepine Trileptal,
Oxtellar XR fatigue, attention problems, hyponatremia Perampanel F ycompa fatigue, dizziness, aggressiveness Pregabalin Lyrica weight gain, dizziness, drowsiness, ataxia Primidone Mysoline nervousness, drowsiness Steroids risk of death due to damage to the immune system (about 1%), worsening of infectious disease Sultiam Ospolot shortness of breath, paresthesia, nephrolithiasis 901 99 Tiagabine Gabitril dizziness, drowsiness, tremor, abdominal pain, diarrhoea, nervousness, fatigue0199

weight loss, paresthesia, depression or nervousness, glaucoma, anhidrosis and fever (in children), nephrolithiasis Felbamate Felbatol no permanent follow-up by an epileptologist Phenobarbital Luminal,
Solfoton nervousness, drowsiness Phenytoin Dilantin, Phenytoin Sodium gum hyperplasia, increased hair growth. Rare: cerebral atrophy, polyneuropathy (with long-term treatment)

Side effects of anticonvulsants are reversible!

• Weight gain can be corrected with diet and exercise.
• Slight weight loss can be compensated by a high-calorie diet.
• Drowsiness or hyperactivity can be completely or partially eliminated by changing the dosage or timing of medication.

You can adjust your dosage, add vitamins or nutritional supplements to your diet, change your medication, and many of the side effects of antiepileptic drugs will go away.

There are several drugs with irreversible side effects, but they are used only in cases of severe epilepsy, when there is a danger to the patient and their use cannot be avoided.

Conclusion

Taking any anticonvulsants carries a risk of side effects, but this does not mean that you will have them. The choice of drug is determined primarily by its effectiveness in the treatment of this type of epileptic seizures.

Your epileptologist must anticipate possible side effects and choose a drug with which you will live in peace and harmony for at least a few years.

Remember that you are responsible for your own treatment, so be sure to contact your epileptologist if you notice side effects from the drug. The treatment of epilepsy must be approached seriously and responsibly.

1. At the appointment of an epileptologist, take an active part in discussing the treatment plan. Learn about the possible negative effects of the drug you are prescribed, as well as possible ways to deal with them.
2. During treatment, strictly follow the regimen, time of administration and prescribed dosage of medications. Do not skip taking the drug, as frequent skips can negate the entire result of the treatment.
3. Stay in touch with your treating epileptologist. For early detection of side effects, it is necessary to periodically assess the patient’s condition and control laboratory tests, including analysis of the level of the drug in the blood. This is especially important at the beginning of therapy or when making any changes to the treatment protocol.
4. At the first signs of side effects from taking antiepileptic drugs, immediately contact your treating neurologist.

---

Do you want to know what really helps with epilepsy and how to live life to the fullest despite the disease?

Once a week we release a video or article about epilepsy treatment. This is a FREE and the only email newsletter of its kind in the world and we are sure that you will find a lot of useful recommendations in these editions.

The first issue you will receive is the Top 9 Questions and Answers About Epilepsy.

1. Can epilepsy be cured?
2. Is epilepsy hereditary?
3. Do alternative treatments help control seizures?
4. What not to do with epilepsy?
5. How much sleep should a patient with epilepsy sleep?
6. Why are epilepsy attacks dangerous during sleep?
7. How to help a patient during an attack?
8. Can I play sports?
9. Can epilepsy lead to learning problems, developmental delays, memory and behavior problems?

Enter your email address and check your mail in 5 minutes

“Advice from a pediatric epileptologist”

---

“Advice from an epileptologist for adults” 9000 5

---

***We appreciate you and your trust. Our goal is to provide you with reliable information about the treatment of epilepsy, and to try to help you or your children live with this serious illness. Under no circumstances will your data be shared or sold to third parties. Like you, we don’t like receiving useless mail or advertisements, and we’ll do our best to live up to your trust.

---

---

Read Children’s Epilepsy A to Z by pediatric epileptologist Professor Uri Kramer

Learn how to help your child live the best possible life despite epilepsy. The author is the famous children’s epileptologist Professor Uri Kramer. Publisher: Migdal Medical clinic (Israel, 2023)

The book is written in simple language for moms and dads, full of practical advice and recommendations from an expert epileptologist with a worldwide reputation.

In Professor Kramer’s book, you will find answers to many of your questions about epilepsy in children, from types of seizures, correct diagnosis, effective treatments, to practical advice on how to improve your child’s quality of life and prepare him for independent adulthood.