Keppra (Levetiracetam)

Levetiracetam is an anticonvulsant that targets neuronal excitability in epilepsy.

• Partial seizures: Reduces frequency and severity of focal onset seizures.
• Generalized tonic-clonic seizures: Helps prevent convulsive episodes in patients with generalized epilepsy.
• Myoclonic seizures: Controls rapid, brief muscle jerks associated with myoclonic epilepsy.

• Levetiracetam binds to the synaptic vesicle protein SV2A, a key regulator of neurotransmitter release. This interaction modulates calcium‑dependent exocytosis, decreasing neuronal hyper‑excitability and stabilizing synaptic transmission. By reducing the release of excitatory neurotransmitters, the drug lowers the likelihood of seizure initiation without directly affecting ion channels or GABA receptors. It does not significantly bind to other receptor systems, contributing to its relatively selective profile.

Levetiracetam may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Dizziness: Sensation of light‑headedness or unsteadiness.
• Fatigue: Generalized tiredness or lack of energy.
• Somnolence: Increased sleepiness or drowsiness.
• Headache: Mild to moderate cranial pain.
• Irritability: Mood changes including agitation.
• Nausea: Stomach upset or feeling sick.

Serious or Rare Side Effects

• Severe allergic reaction: Rash, swelling, or difficulty breathing.
• Stevens‑Johnson syndrome: Rare skin disorder with blistering.
• Suicidal thoughts: New or worsening depressive symptoms.
• Severe depression: Persistent low mood affecting daily function.
• Blood disorders: Low white blood cells or platelets.
• Liver injury: Elevated enzymes indicating hepatic stress.

When prescribing levetiracetam, clinicians should consider several safety measures to minimize risk.

• Renal function: Assess and adjust dose in patients with impaired kidney function.
• Psychiatric history: Monitor for mood changes, depression or suicidal ideation.
• Discontinuation: Avoid abrupt cessation; taper gradually under medical supervision.
• Drug interactions: Review concomitant medications that may alter levetiracetam levels.
• Pregnancy: Use only if potential benefit justifies potential risk; data limited.
• Store at room temperature: Keep in original packaging, protect from moisture and light.

Levetiracetam can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Carbamazepine: Increases metabolism, reducing levetiracetam plasma concentrations.
• Phenytoin: Induces hepatic enzymes, leading to lower drug levels.
• Rifampin: Strong enzyme inducer that markedly decreases levetiracetam exposure.

Moderate Interactions (Monitor Closely)

• Valproic acid: May increase levetiracetam concentrations, requiring dose adjustment.
• CNS depressants: Additive sedation when combined with alcohol or other sedatives.