Levetiracetam (Keppra)

When is levetiracetam used ?

Levetiracetam is used in both partial and generalized epilepsy syndromes. It is approved to treat partial-onset seizures in patients 4 years or older and myoclonic seizures in patients aged 12 years or older with juvenile myoclonic epilepsy.

Levetiracetam is generally not effective against absence seizures or infantile spasms. However, levetiracetam is often used in other generalized seizure syndromes.

What are the most common side effects of levetiracetam ?

Most people who take levetiracetam have no or few side effects. Those that do most often complain of:

  • sleepiness
  • loss of strength and energy
  • dizziness
  • anxiety
  • nervousness
  • irritability
  • other mood changes

If any of these problems persist beyond the first few weeks of treatment or are particularly severe, call the doctor's office. Sometimes the doctor can help by changing the amount or dosage schedule of levetiracetam. However, you should never stop taking a medication or change the amount you take without the doctor's guidance.

Some people have reported helpful effects from levetiracetam. They say they can think and concentrate better and feel more alert. It is hard to be sure whether these benefits are from the levetiracetam or from having fewer and less severe seizures.

If you have just started taking levetiracetam (or have just started taking a larger amount), be careful doing anything that might be dangerous until after being on the medication (or higher dose) for a few weeks.

What are the most serious side effects of levetiracetam ?

Very few people have serious reactions to levetiracetam. If you take it, you should be aware of them, however, so you and your family can recognize them. If you notice any of these symptoms, call your doctor right away:

  • decreased ability to cope with daily life events
  • depression
  • thoughts of suicide
  • severe anxiety, agitation, or confused thought

It is important to remember that only a tiny percentage of people who take levetiracetam have any serious problems.

Who should not take levetiracetam ?

The only people who definitely should not take levetiracetam are those who are allergic to it or any of its inactive ingredients.

People with kidney disorders need to be extra careful, however, as levetiracetam may build up to a level that's too high unless very low doses are taken.

Additionally, people with a history of suicidal thoughts or attempts should probably avoid this medication, as should people with certain psychiatric diseases.

Can levetiracetam be taken with other medicines ?

Sometimes one kind of medicine changes the way another kind of medicine works in the body. Taking levetiracetam does not seem to cause this kind of problem. In addition, it does not affect the level of other medicines in the body, and other medicines do not clearly affect levels of levetiracetam.

If a woman takes levetiracetam during pregnancy, will it hurt the baby ?

In the United States, the Food and Drug Administration (FDA) assigns each medication to a Pregnancy Category according to whether it has been proven to be harmful in pregnancy. Levetiracetam is listed in Pregnancy Category C. This indicates that caution is advised, but the benefits of the medicine to the mother may outweigh the potential risks to the baby. Studies in animals have shown some harm to the baby, but there have been no good studies in women.

All women who are capable of becoming pregnant should take at least 0.4 mg (400 mcg) of the vitamin called folic acid every day because it helps to prevent specific birth defects called Neural Tube Defects. (The most well-known of these is spina bifida, in which the spinal cord is not completely enclosed.) Women with epilepsy should take between 1 and 4 mg of folic acid daily during their reproductive years. If the doctor thinks a woman is at especially high risk, the larger dose of folic acid—4 mg (4000 mcg) per day—may be recommended, beginning before the woman becomes pregnant.

Some babies born to mothers taking antiepileptic medications have had inadequate blood clotting within the first 24 hours after birth. It is often recommended that the mother be given 10 to 20 mg of vitamin K per day during the last month of pregnancy to prevent this problem.

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. This appears to be particularly true for levetiracetam. Levetiracetam levels have been found to drop significantly and quickly in pregnant women. Your doctor will not only want to check levels of medicine in the blood regularly during pregnancy, but may want to increase your dose as soon as the pregnancy is discovered. Similarly, these changes revert back to normal just after delivery and your doctor will then again discuss with you how to begin lowering levetiracetam once the baby is born.

Levetiracetam in the mother’s blood passes nearly completely into breast milk, however how much of this actually enters the baby’s bloodstream is not known. Further, how levetiracetam affects the baby is unknown. That said, it is strongly felt by neurologists and epileptologists that the benefits of breastfeeding largely outweigh the risks of exposing the baby to antiepileptic medications, including levetiracetam. As a matter of fact, the American Academy of Neurology and the American Epilepsy Society both recommend breastfeeding in women with epilepsy.