Keppra (Levetiracetam) - Oral

What Is Keppra?

Keppra (levetiracetam) is a prescription antiepilepsy drug (AED) used for preventing seizures due to epilepsy. It can be prescribed for adults and for children who are aged 1 month or older.

This medication binds to a protein in the brain called the synaptic vesicle protein SV2A. This protein is thought to be involved in regulating the release of certain neurotransmitters in the brain. It is not fully known how this action plays a role in seizure prevention. 

Levetiracetam is available as a standard tablet, extended-release tablet, and as a solution for injection. It is also available as an orally disintegrating tablet (ODT) under the brand name Spritam.

Drug Facts

Generic Name: Levetiracetam

Brand Name(s): Keppra, Keppra XR, Elepsia XR, Spritam, Roweepra

Administration Route(s): Oral

Drug Availability: Prescription

Therapeutic Classification: Anticonvulsant

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Levetiracetam

Dosage Form(s): Tablet, extended-release tablet, tablet for suspension, solution

What Is Keppra Used For?

The Food and Drug Administration (FDA) approved Keppra to prevent several different types of seizures.

Keppra is used to prevent:

  • Partial-onset seizures for adults and children who are 1 month or older. Partial onset seizures begin with abnormal nerve activity in a small area of the brain. They may remain focal in a localized area of the brain, often with limited symptoms (such as one limb jerking or stiffening), or they can involve both sides of the brain, sometimes with extensive effects, such as loss of consciousness and uncontrolled movements of the body. 
  • Adjunctive (add-on) therapy for preventing seizures in juvenile myoclonic epilepsy (JME) for adults and children aged 12 years and older. JME is an epilepsy syndrome that begins during childhood or adolescence, causing several types of seizures. 
  • Adjunctive therapy for preventing idiopathic primary generalized tonic-clonic seizures for adults and children aged 6 years or older. Idiopathic primary generalized tonic-clonic seizures occur without a known cause and begin on both sides of the brain, causing jerking and stiffening of the body. 

Adjunctive seizure medication is recommended for use with another AED because it isn’t expected to prevent seizures when used alone.

Keppra (Levetiracetam) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Keppra

You can take Keppra tablets or oral solution with or without food. This medication is usually taken twice per day. Your healthcare provider will let you know how much to take and when to take it.

If you or your child cannot swallow tablets, ask your healthcare provider for the oral solution.

For the ODT, allow the tablet to dissolve on your tongue completely before swallowing. On average, it will take the tablet 11 seconds to dissolve. For regular immediate-release tablets, you can dissolve it in water and swallow the content if needed.

Storage

You should keep Keppra in its original container and away from the reach of children or pets. This medication should be stored at a temperature of 77 degrees Fahrenheit (F). It can be briefly taken in temperatures between 59 degrees F and 86 degrees F.

Off-Label Uses

Healthcare providers sometimes prescribe Keppra off-label for treating medical issues that are not FDA-approved. In these situations, your dose may differ from the standard dose. When taking Keppra off-label, make sure you monitor the symptoms and let your healthcare provider know if you are improving with Keppra.

Off-label uses of Keppra include: 

  • Use for seizure prevention in babies younger than 1 month of age 
  • Prevention of neuropathic pain 
  • Migraine prevention
  • Prevention of psychiatric symptoms including depression, body dysmorphia, bipolar disorder symptoms
  • Acute repetitive seizures and status epilepticus

If you are prescribed Keppra to treat an off-label indication, you can experience similar side effects to when taking Keppra for an indicated condition.

How Long Does Keppra Take to Work?

Typically, this medication begins to work within a few hours of taking it. It may take several days to reach its full effect for seizure prevention.

What Are the Side Effects of Keppra?

The common side effects of Keppra can be mild. However, Keppra can cause significant side effects that may interfere with your quality of life.

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects of Keppra differ slightly based on age. 

The most common side effects in adults include:

  • Severe tiredness
  • Weakness and lack of energy
  • Infections
  • Dizziness

The most common side effects in children include: 

  • Fatigue
  • Aggression
  • Nasal congestion
  • Decreased appetite
  • Irritability

Make sure to tell your healthcare provider if you or your child experiences side effects of Keppra.

Severe Side Effects

Keppra can cause serious and potentially life-threatening side effects that should be treated promptly.

Severe side effects of Keppra can include:

  • Low blood pressure 
  • Mood changes 
  • Psychotic symptoms
  • Suicidal thoughts or behavior
  • Irritability 
  • Aggression 
  • Severe skin reactions 
  • Balance and coordination problems
  • Trouble waking

Get medical attention right away if you experience any of these symptoms.

Long-Term Side Effects

Keppra is a relatively quick-acting medication with short-acting effects. You should not have long-term side effects after you stop taking Keppra.

Report Side Effects

Keppra may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (1-800-332-1088).

Dosage: How Much Keppra Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release tablets):
    • For treatment of partial-onset seizures:
      • Adults and children 12 years of age and older and weighing 50 kilograms (kg) or more—At first, 1000 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children younger than 12 years of age—Use and dose must be determined by your doctor.
  • For oral dosage form (Keppra® solution or tablets):
    • For partial onset seizures:
      • Adults and children 16 years of age and older—At first, 500 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children 4 to 15 years of age—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 10 milligrams (mg) per kilogram (kg) of body weight 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per kg of body weight per day.
      • Children 6 months to 3 years of age—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 10 mg per kg of body weight 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 50 mg per kg of body weight per day.
      • Children 1 to 5 months of age—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 7 mg per kg of body weight 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 42 mg per kg of body weight per day.
      • Children younger than 1 month of age—Use and dose must be determined by your doctor.
    • For juvenile myoclonic seizures:
      • Children 12 years of age and older—At first, 500 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children younger than 12 years of age—Use and dose must be determined by your doctor.
    • For primary generalized tonic-clonic seizures:
      • Adults and children 16 years of age and older—At first, 500 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children 6 to 15 years of age—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 10 milligrams (mg) per kilogram (kg) of body weight 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 60 mg per kg of body weight per day.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.
  • For oral dosage forms (Spritam® tablets, Spritam® tablets for suspension):
    • For partial onset seizures:
      • Adults and children 4 years of age and older weighing over 40 kilograms (kg)—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 500 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children 4 years of age and older weighing 20 to 40 kg—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 250 mg 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1500 mg per day.
      • Children younger than 4 years of age and weighing less than 20 kg—Use is not recommended.
    • For juvenile myoclonic seizures:
      • Children 12 years of age and older—At first, 500 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children younger than 12 years of age—Use and dose must be determined by your doctor.
    • For primary generalized tonic-clonic seizures:
      • Adults and children 6 years of age and older weighing over 40 kilograms (kg)—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 500 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children 6 years of age and older weighing 20 to 40 kg—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 250 mg 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1500 mg per day.
      • Children younger than 6 years of age and weighing less than 20 kg—Use is not recommended.

Modifications

In some cases, your healthcare provider may modify your treatment with Keppra by changing your dose or switching your medication altogether.

Pregnancy

The physiological changes that occur when pregnant may affect the levels of Keppra in your body, especially during the third trimester. Your healthcare provider may adjust your dose of Keppra and monitor for any negative effects. If your dose is changed during pregnancy, close monitoring is also recommended through the postpartum period. Of note, there are no adequate and well-controlled studies of levetiracetam in people who are pregnant. Therefore, the potential risk should always be compared to the benefit of staying on the medication while pregnant.

Breastfeeding

Keppra can pass through human breast milk. Although there are no data on the effects of this medication on a breastfed infant or milk production, it is recommended to consider any side effects that might occur. Talk with your healthcare provider about your options. 

Kidney Problems

People with kidney impairment may require a dose adjustment. Supplemental doses should be given after dialysis. 

Missed Dose

If you miss a dose of Keppra, take the missed dose as soon as possible. If it is almost time for your next dose, skip the missed dose. Go back to your regular dosing schedule. Do not double up on doses.

Overdose: What Happens If I Take Too Much Keppra?

Taking too much Keppra can increase the risk of side effects, including severe problems with balance and/or blood pressure changes.

Tell your healthcare provider if you have taken too much Keppra. Seek emergency medical attention if you begin to experience symptoms of an overdose. You would need to be monitored and may receive treatment for symptoms of an overdose. Treatment can include medically-induced vomiting or a procedure to directly remove the drug from the stomach.

What Happens If I Overdose on Keppra?

If you think you or someone else may have overdosed on Keppra, call a healthcare provider or the Poison Control Center (1-800-222-1222).

If someone collapses or isn't breathing after taking Keppra, call 911 immediately.

Precautions

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It is very important that your doctor check your or your child's progress at regular visits, especially for the first few months you or your child are using this medicine. This is to see if the medicine is working properly and to allow for a change in the dose. Blood tests may be needed to check for any unwanted effects.

It is important to tell your doctor if you become pregnant while using this medicine. Your doctor may want you to join a pregnancy registry for patients taking a seizure medicine.

Levetiracetam may cause changes in mood or behavior, problems with coordination, or unusual tiredness or weakness. Tell your doctor right away if you or your child start to feel depressed, anxious, angry, getting upset easily, restless, or have thoughts about hurting yourself. Report any unusual thoughts or behavior that trouble you, especially if they are new or getting worse quickly.

This medicine may cause some people to become dizzy, drowsy, tired, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may cause serious allergic reactions, including anaphylaxis or angioedema, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, trouble breathing or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Serious skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis) can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, chills, cough, diarrhea, itching, joint or muscle pain, red irritated eyes, red skin lesions, sore throat, sores, ulcers, or white spots in the mouth or on the lips, or unusual tiredness or weakness while you are using this medicine.

Do not stop using levetiracetam without first checking with your doctor. Stopping the medicine suddenly may cause your seizures to return or to occur more often. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

What Are Reasons I Shouldn’t Take Keppra?

Do not take Keppra if you have a known allergy to levetiracetam or any of its ingredients. An allergic reaction can cause angioedema and anaphylaxis.

What Other Medications Interact With Keppra?

Keppra does not usually cause harmful drug interactions. It is frequently taken with other AEDs for seizure prevention.

What Medications Are Similar?

Keppra is one of many AEDs used for preventing seizures.

Similar antiseizure medications include:

  • Briviact (brivaracetam)
  • Lamictal (lamotrigine)
  • Phenobarbitol
  • Valproate and divalproex sodium

Frequently Asked Questions

  • What is Keppra used for?

    Keppra is indicated for the prevention of seizures for adults and children who are 1 month of age and older. It is also prescribed off-label for the treatment of some mood and pain conditions.

  • How does Keppra work?

    Keppra has been found to impact nerve activity in the brain by binding to proteins that are located on the nerves.

  • What drugs should not be taken with Keppra?

    Keppra can be taken with most other over-the-counter and prescription drugs. However, make sure you tell your healthcare practitioner and pharmacist about any medications, supplements, or herbs that you are taking.

  • How long does it take for Keppra to work?

    Typically, this medication begins to work within a few hours of taking it. It may take several days to reach its full effect for seizure prevention.

  • What are the side effects of Keppra?

    Keppra can cause fatigue, dizziness, balance problems, and infections. It can also cause serious behavioral and mood changes, especially for children.

  • How do I stop taking Keppra?

    Stopping Keppra must be gradual and should follow a schedule provided by your healthcare provider. You can have withdrawal seizures if you suddenly stop taking Keppra. You might need to take another AED to substitute for Keppra when you stop taking it.

How to Stay Healthy While Taking Keppra

If you are taking Keppra, it is important that you monitor your symptoms and side effects and talk to your healthcare team about whether the medication is working.

Tips to stay healthy while taking Keppra include:

  • Avoid seizure triggers, including alcohol, sleep deprivation, flashing lights, skipping meals, and fevers.
  • Take your medication as prescribed.
  • Do not skip doses or take extra doses of Keppra.
  • Have a plan in place for managing seizures if you have any.
  • Have a plan to get medical attention if you have a severe seizure.
  • Talk to your healthcare provider about whether you have permission to drive or operate potentially dangerous machinery.

Medical Disclaimer

Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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