Levetiracetam (Keppra)

Introduced 1999

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Partial-onset seizuresMyoclonic seizuresPrimary generalized tonic-clonic seizuresBipolar disorder (off-label)Behavioral dysregulation (off-label)

Mechanism

Binds to synaptic vesicle protein 2A (SV2A), reducing neurotransmitter release and stabilizing neuronal activity.

Dosing

Adult Dosing

seizures: Start 500 mg twice daily, increase by 500 mg twice daily every 2 weeks to max 1500 mg twice daily

psychiatric off label: Commonly 500–1500 mg twice daily; titration individualized

Dosage Forms

Tablets: 250 mg, 500 mg, 750 mg, 1000 mg
Oral solution: 100 mg/mL
IV solution: 100 mg/mL

Onset Duration

Onset within days; steady state achieved after 2 days of twice-daily dosing.

Adverse Effects

Common Side Effects

• somnolence

• asthenia

• dizziness

• irritability

⚠️ Serious Side Effects

psychosis
suicidal ideation
severe allergic reactions

Warnings

Critical Safety Information

→Monitor for behavioral changes including aggression and irritability
→Avoid abrupt discontinuation to reduce risk of seizure recurrence

Interactions

With: CNS depressants

Risk: Additive sedation

Action: Use caution

With: Enzyme-inducing antiepileptics

Risk: Minor pharmacokinetic interactions

Action: Monitor

Monitoring

Mood and behavior
Renal function
Adherence

Special Populations

👶Pregnancy

Limited data; use if benefits outweigh risks

🤱Breastfeeding

Excreted in breast milk; monitor infant for sedation

👧Children & Adolescents (Under 18)

Approved for seizure disorders from 1 month of age

👴Older Adults (65+)

Adjust dose for renal function

Tapering

Taper gradually over at least 1 week to avoid rebound seizures.

Clinical Notes

Generally well tolerated, but can cause significant behavioral side effects in some patients
No significant hepatic metabolism—few drug-drug interactions

This medication information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication. Never take medication without a prescription from a licensed healthcare provider.

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