Keppra: Effective Seizure Control with Proven Tolerability
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Synonyms | |||
Keppra (levetiracetam) is an antiepileptic drug (AED) indicated as adjunctive therapy in the treatment of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children with epilepsy. Its unique mechanism of action, binding to the synaptic vesicle protein 2A (SV2A), differentiates it from traditional AEDs and contributes to its favorable pharmacokinetic and safety profile. As a second-generation medication, it offers neurologists and patients a valuable therapeutic option with a well-established efficacy record and a generally predictable side effect landscape, making it a cornerstone in modern epilepsy management protocols.
Features
- Active pharmaceutical ingredient: Levetiracetam
- Available in multiple formulations: film-coated tablets (250 mg, 500 mg, 750 mg, 1000 mg), oral solution (100 mg/mL), and injectable solution (100 mg/mL) for intravenous use
- Rapid and almost complete absorption following oral administration; bioavailability is not food-dependent
- Linear, time-invariant pharmacokinetics; steady-state achieved within 2 days with twice-daily dosing
- Primarily eliminated renally (66% of dose) as unchanged drug; metabolism is minimal and not hepatic cytochrome P450 dependent
- Low plasma protein binding (<10%)
Benefits
- Demonstrates high efficacy in reducing seizure frequency across multiple seizure types in both adults and pediatric populations.
- Offers a favorable side effect profile with a low potential for pharmacokinetic drug-drug interactions, simplifying polytherapy regimens.
- Provides flexible dosing and administration options (oral and IV), supporting use in both outpatient and inpatient settings, including status epilepticus management.
- Features a rapid titration schedule, allowing for efficient achievement of therapeutic doses.
- Shows no requirement for routine therapeutic drug monitoring in most patients, reducing treatment burden and cost.
- Is generally well-tolerated, supporting long-term adherence and improved quality of life for patients with chronic epilepsy.
Common use
Keppra is primarily used as adjunctive therapy for the management of partial onset seizures with or without secondary generalization in adults and children 4 years of age and older. It is also approved as monotherapy for the treatment of partial onset seizures in adults and adolescents 16 years and older with newly diagnosed epilepsy. Furthermore, it is indicated for adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy, and for the adjunctive treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy. Its use has also been explored off-label in conditions such as neuropathic pain, migraine prophylaxis, and bipolar disorder, though robust evidence for these indications is still evolving.
Dosage and direction
The initial dosage for adults and adolescents (16 years and older) is 500 mg twice daily, which can be increased by 500 mg twice daily every 2 weeks to a recommended maximum dose of 3000 mg per day. For pediatric patients, dosing is weight-based. For partial onset seizures in children 4 to <16 years: 10 mg/kg twice daily, increased every 2 weeks by 10 mg/kg twice daily to a recommended dose of 30 mg/kg twice daily. For primary generalized tonic-clonic seizures in children 6 to <16 years: 10 mg/kg twice daily, increased every 2 weeks by 10 mg/kg twice daily to a recommended dose of 30 mg/kg twice daily. For intravenous administration, it is bioequivalent to the oral form and can be administered after dilution as a 15-minute IV infusion. Tablets should be swallowed whole with a liquid; the oral solution can be administered with or without food. Dosage adjustment is required in patients with renal impairment.
Precautions
Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and unusual changes in mood or behavior. Neuropsychiatric adverse reactions, including psychosis, hallucinations, and aggression, have been reported. Caution is advised when administering to patients with a history of psychiatric disorders. Patients should be warned about the potential for dizziness and somnolence, which could impair their ability to perform potentially hazardous activities such as driving or operating machinery. Abrupt withdrawal may lead to increased seizure frequency; therefore, discontinuation should be gradual. Use in patients with renal impairment requires dose adjustment based on creatinine clearance. The safety and efficacy in pregnant women have not been established; use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Contraindications
Keppra is contraindicated in patients with a known hypersensitivity to levetiracetam, any of the inactive ingredients, or other pyrrolidine derivatives.
Possible side effect
The most frequently reported adverse reactions (occurring in >10% of patients and more frequently than placebo) are somnolence, asthenia, infection, and dizziness. Other common side effects include:
- Neuropsychological effects: agitation, hostility, anxiety, apathy, emotional lability, depersonalization, depression
- General disorders: fatigue, headache
- Gastrointestinal disorders: nausea, vomiting, anorexia, diarrhea
- Less common but serious side effects may include severe psychiatric symptoms, pancytopenia, Stevens-Johnson syndrome, toxic epidermal necrolysis, and anaphylaxis. Any signs of these require immediate medical attention.
Drug interaction
Formal interaction studies show no clinically significant interactions with digoxin, warfarin, oral contraceptives (ethinylestradiol/levonorgestrel), or probenecid. Due to its primarily renal excretion and lack of significant hepatic metabolism, it has a low potential for pharmacokinetic interactions. However, pharmacodynamic interactions with other CNS depressants (e.g., alcohol, benzodiazepines, barbiturates, other AEDs) may lead to increased sedation. Caution is advised when co-administering with other drugs that cause somnolence.
Missed dose
If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one.
Overdose
Symptoms of overdose are mainly an increase in the severity of dose-dependent adverse effects, including somnolence, agitation, aggression, depressed level of consciousness, respiratory depression, and coma. There is no specific antidote. In the event of overdose, general supportive care is indicated, including monitoring of vital signs and observation of the clinical status of the patient. Hemodialysis is effective, enhancing the clearance of levetiracetam (approximately 50% of the drug is removed in a 4-hour session) and should be considered in cases of severe overdose.
Storage
Store at room temperature between 15°C and 30°C (59°F and 86°F). Keep the tablets in their original blister package or bottle to protect from moisture. The oral solution should be stored in its original bottle, protected from light, and used within 3 months of first opening. Keep all medications out of the reach of children and pets.
Disclaimer
This information is for educational and informational purposes only and does not constitute medical advice. The content provided is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
(Note: As an informational document, specific patient reviews are not included. Clinically, Keppra is generally reviewed positively in the neurological community for its efficacy, rapid titration, and favorable interaction profile. Patient experiences vary, with many reporting significant seizure reduction and good tolerability, while others note side effects like mood changes or fatigue. Its role as a first-line adjunctive therapy is well-supported by extensive clinical trial data and real-world evidence.)