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What is Keppra?

Keppra belongs to a class of drugs called anticonvulsants. Keppra is a prescription medication for treating the symptoms of partial-onset seizures, tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy. Keppra may be taken alone or with other medicines.

The generic version of Keppra is levetiracetam.

What does Keppra treat?

Keppra is an anti-seizure medication that treats the symptoms associated with myoclonic seizures and as adjunctive therapy for partial-onset seizures.

Doctors can also combine Keppra (levetiracetam) with other drugs to treat primary generalized tonic-clonic seizures (seizure that involves the entire body) in patients with epilepsy, both adults and children over six.

These medications regulate brain chemicals that control nerve signals so that seizures don't occur. Keppra may either be taken alone or in combination to treat your condition. You may be prescribed Keppra in addition to your current therapy.

Myoclonic seizures

Myoclonic seizures of juvenile myoclonic epilepsy are seizures that involve the neck, shoulders, and upper arms. Many patients experience their seizures within minutes of waking up.

They usually begin between adolescence and early adulthood. Most people who have epilepsy can control their seizures with medication, but they must continue taking it throughout life.

Partial-onset seizure

Abnormal electrical activity within your brain causes partial-onset seizures. During a seizure, people may experience a variety of different symptoms. Common symptoms of partial-onset seizures include losing consciousness, becoming unconscious, experiencing uncontrolled muscle movements, and experiencing altered sensory perceptions.

Tonic-clonic seizures

A tonic-clonic seizure is usually what most people think of whenever they hear the word "convulsion." Tonic-clonic seizures combine the characteristics of both tonic and clonic convulsions. Tonic means stiffening, and clonic means jerking.

Ask your doctor if you have any questions about why they prescribed Keppra for you.

Keppra is not yet FDA-approved for children younger than four years old.

How do you take Keppra?

Keppra is available in several forms:

  • Tablets (immediate release): 250mg, 500mg, 750mg, and 1000mg. 

  • Tablets (extended release): 500mg and 750mg.

  • Liquid solution: 100mg/ml. 

  • Injection solution: 5mg/ml, 10mg/ml, 15mg/ml, and 100 mg/ml.

Read the Patient Information Leaflet provided by your pharmacist before starting levetiracetam. If you have any further concerns or questions, ask your healthcare provider.

Take the medication as directed by your doctor, twice daily with or without meals.

Liquid form

If you're using the liquid form of the medicine, carefully measure the dose by using a medical measuring device. For example, use the measuring cup that comes with the medication instead of a household spoon. Using the right tool means you’ll get the correct amount and avoid any symptoms reappearing.

Tablet form

Take this drug as instructed by your healthcare provider, usually once daily.

Do not break or chew Keppra pills. This can create a bitter taste and affect how your body processes the medicine. This can increase the risks of side effects. Don’t split tablets if they don't have a score line unless your doctor or pharmacist tells you to.

Your doctor bases the dose on your medical condition and how your body responds to treatment. The dosage in children depends on their weight. To lessen the chances of side effects, your doctor may suggest starting this medication at a low dosage and gradually increasing your dosage. Follow their directions carefully.

For liquid injection

The dose is 100mg per 1mL (milliliters). In 2006, the FDA approved Keppra as an alternative for patients with seizures who cannot take their medicine orally.

It must be diluted before use according to the package insert and administered as a 15-minute intravenous (IV) infusion.

Daily dose for juvenile myoclonic epilepsy

Your doctor will start treatment with a dose of 1000mg per day (500mg twice daily) for the first week. Increase the dosage by 1000mg per day every two weeks to the recommended daily dosage of 3000mg. Researchers have not studied the effectiveness of doses below 3000mg per day.

Daily dosage for primary generalized tonic-clonic seizures

For adolescents and adults aged 16 years and older

Your doctor will start treatment with a dose of 1000mg per day (as 500mg twice daily) for the first week. Increase the dosage by 1000mg per day every two weeks to the recommended daily dosage of 3000mg. Researchers have not studied the effectiveness of doses above 3000mg per day.

For pediatric patients aged 6 to 16 years

Your doctor will start treatment with a daily dose between 20 and 30mg/kg in two equally divided doses. Increase the daily dose of the medication every two weeks by increments of 10mg/kg (5mg/kg twice daily) until the recommended daily dose of 30mg/kg (15mg/kg twice daily is reached). There are no adequate studies on the effectiveness of doses lower than 30mg/kg per day.

Daily dosage for partial-onset seizures

For adolescents and adults aged 16 years and older

Your doctor will start treatment with a dose of 1000mg per day (as 500mg twice daily) for the first week. Your doctor may give additional doses up to 1000mg per day to the maximum recommended daily dosage of 3000mg. Researchers have not studied the effectiveness of doses below 3000mg per day.

For pediatric patients from 1-6 months

Your doctor will start treatment at a dose of 7mg/kg twice daily. Increase the daily dose by increments every two weeks until you reach the recommended daily dose (21mg/kg twice daily).

For pediatric patients aged six months to under four years

Your doctor will start treatment with a daily dose equal to 20mg/kg divided into two 10mg/kg doses twice daily. They will increase the daily dose by 20mg/kg every two weeks until reaching the recommended daily dose of 50mg/kg (25mg/kg twice daily). If your child cannot tolerate 25mg/kg, your doctor may reduce the daily dosage.

Take this medication regularly to get the maximum benefit from it. To help you remember better, take it at the same time every day.

You may need to give your child levetiracetam (Keppra) for several weeks before you see a decrease in seizures. If there is no decrease after two weeks, contact your healthcare provider.

Do not increase your dosage or use this drug more frequently than prescribed. Your condition will not improve any faster, and your chances of experiencing side effects of levetiracetam will increase.

Potential side effects of Keppra

These potential reactions are most likely to occur during the first four weeks of treatment. They may lessen as your body adjusts. Tell your doctor if any side effects persist or become bothersome.

Common side effects include:

  • Drowsiness

  • Dizziness

  • Unusual tiredness

  • Weakness

  • Upper respiratory tract infections 

Remember, your doctor has prescribed Keppra as they have determined that the benefits outweigh the risks. Many people taking this drug do not have severe reactions.

Talk to your healthcare provider right away if you have any severe side effects, such as:

  • Sore throat that doesn't go away

  • Fever or chills

  • Difficulty walking and controlling muscles

  • Mood changes

  • Panic attack, agitation, restlessness, or nervousness

  • Signs of anemia

  • Easy bruising/bleeding

  • Loss of balance

A few patients taking anticonvulsant medications for any condition (such as seizures, bipolar disorder, pain) may develop depression, suicidal thoughts/attempts, or other mental health issues.

Tell your doctor immediately if you, your family, or your caregiver notice any of these symptoms:

  • Unusual or sudden changes in your mood, thinking, or behavior

  • Signs of depression

  • Suicidal thoughts

  • Thoughts about harming yourself

Levetiracetam may cause a rash, which is usually not serious. However, you may be unable to tell whether it's a rash indicating an allergic reaction. If you develop any rashes, tell your doctor right away.

Get immediate medical attention if you experience any symptoms of a severe allergic reaction:

  • Rash

  • Itching/swelling (especially on the face/tongue/throat)

  • Severe dizziness

  • Trouble breathing

If you experience any other side effects, let your doctor know.

Long-term use of Keppra

As Keppra is a relatively new medicine, no studies have shown lasting harmful effects if you take it over many months or years.

There is no evidence to suggest that Keppra is addictive.

Missed doses

It's important to take this medicine regularly. If you miss doses, you may experience a seizure.

If you forget to take your medicine, take it as soon as you remember and then return to taking it as normal. If it's less than 8 hours before your next dose, skip the missed dose and take it at your usual time.

Don't take an extra dose to compensate for a forgotten one.

If you forget doses, it may be helpful to set an alarm to remind you. You could also ask the pharmacist for advice on ways to help you remember to take your medicine.

Overdoses

Taking too much Keppra can result in severe side effects, and it can be dangerous.

Symptoms of a Keppra overdose include the following:

  • Loss of consciousness

  • Aggression

  • Shallow breathing

  • Drowsiness

  • Agitation

  • Weakness

Call 911 or go to your nearest emergency room if you or someone you care for overdoses on Keppra.

What to discuss with your doctor before you start taking Keppra

  • Any allergies you may have to levetiracetam (Keppra), any other medications, and any other allergies

  • Any prescription and nonprescription drugs, vitamins, nutritional supplements, and herbal products you take or plan to take. You may need to adjust the doses of your medications.

  • Tell your doctor if you have any of these conditions: Kidney disease, depression, low moods, or suicidal thoughts.

  • If you're pregnant, planning to get pregnant, or breastfeeding. Contact your doctor immediately if you become pregnant while taking Keppra.

Stopping Keppra

Limited research suggests children should be seizure-free for two years and adults for two to five years before they consider stopping the medication. It's hard to know whether you've been seizure-free because your medicine is working or your epilepsy has gone away.

Changing your medication may be better for your health than taking the same one. There are over 20 epilepsy medications available, so you can work with your doctor to find the right one for you.

What you should expect

More than half of patients who stop taking their epilepsy medications remain seizure-free for at least one year. However, the chances of relapse can still be as high as 25%, even among people with the most optimistic outlooks for stopping treatment.

The likelihood of having a seizure during the first two years after stopping medication is doubled compared to when you were on the medications. After that, there isn't any difference.

If seizures return, there's a good chance they can be well-controlled with medication again, but you may not immediately see results. For some people, this may take up to two years.

As there's no way to be sure whether seizures will recur, you must work closely with your doctor before and after deciding to stop taking medication.

Keppra and pregnancy

Levetiracetam is pregnancy category C. The FDA advises caution, but the potential benefits of the medication (that is not having a seizure) may outweigh any potential risks.

Animal studies suggest that levetiracetam may be harmful to the developing fetus. If you are pregnant or plan to get pregnant, talk to your doctor.

The risk of congenital disability is generally higher in children whose mothers take more than one seizure medication at the same time and have a family history of having a child born with a congenital disability. Therefore being on a single agent at the lowest possible dose may be recommended.

Risks during pregnancy

Some women may experience more seizures during pregnancy due to hormonal changes and how their bodies handle seizure medication. In the case of Levetiracetam, levels gradually decrease during pregnancy and thus the dosage needs to be closely monitored by a doctor.

Talk to your doctor before becoming pregnant about seizures and if any medicines need to change. They will tell you when they need to check your blood levels of medication during pregnancy. During and after pregnancy, the dose of seizure medicine may have to be adjusted.

Breastfeeding

Low drug levels have been found in breastmilk when nursing mothers have taken average doses of levetiracetam. It’s unlikely to cause any problems for a baby. However, levetiracetam could affect a woman's ability to produce breast milk.

If you choose to breastfeed while taking anticonvulsants, check your baby for drowsiness and keep track of their growth and development if you're taking more than one seizure medication.

Talk to your healthcare team about any concerns that may arise with breastfeeding.

Interactions with other drugs

You should never take certain medications together. In some cases, though, you may need to take two medicines together even if there could be an adverse effect or unwanted drug interaction. If your doctor wants to change the dose, they may need additional precautions.

Your healthcare provider must know if you are taking any other medications when taking levetiracetam. The following interactions have all been selected based on their potential significance and are by no means all-inclusive.

These medications are usually not recommended for combination, but your doctor may deem it necessary:

  • Calcifediol

  • Methotrexate

  • Orlistat

If you use this drug with any of these medicines, there may be an increased risk of severe specific side effects. However, using both drugs may be better than either one alone. Your doctor may adjust the dose or frequency of your medicines if you’re taking them together.

  • Carbamazepine

  • Ginkgo

Other interactions

Drinking alcohol with this drug may increase the risk of unwanted side effects. It can also increase seizure risk.

Other medical problems

Other medical conditions may affect the use of these medicines. Make sure you tell your doctor if you have any additional health issues, especially:

  • Depression

  • Hypertension

  • History of mental illness

  • Kidney disease

Allergy information

People allergic to Keppra and its ingredients should not use this medication. Check the product label for a list of ingredients, and tell your doctor about any allergies.

Allergic reaction symptoms include: 

  • Hives/rash

  • Restricted breathing

  • Difficulty swallowing

  • Swelling (especially in the face and throat)

Discuss your allergies with your doctor so they can adjust your prescription accordingly.

Clinical trial history

Some seizure medications don't work for everyone. Your doctor may try a series of medicines or a combination to find one that’s most effective for you.

  • Most studies¹ showed that approximately 20 to 40% of patients experienced at least a 50% reduction in their seizures when taking levetiracetam with other seizure medications.

  • One study¹ found that levetiracetam may be helpful when taken alone in people with focal (partial) seizures.

Tips and advice for taking Keppra

  • After trying a dose for at least two weeks, your doctor may increase or decrease the amount depending on whether it's working well enough for you.

  • A child who weighs at least 20 kilograms (44 pounds) should take the tablet form of Keppra.

  • Don't crush, chop, or chew the pill, as this can increase side effects.

  • If you or your children are having trouble swallowing the tablets whole, ask your healthcare professional if you can switch to an oral solution (liquid) form.

  • Take the oral solution as prescribed and use the provided measuring cup.

  • If you observe any changes in your mood or thoughts, or if your child is acting strangely after taking Keppra, tell your doctor. Call 911 or go to the nearest hospital if you're thinking of hurting yourself.

  • Keppra may cause drowsiness, fatigue, weakness, or difficulty in movement and coordination. Don't drive, operate machinery, or do anything that requires concentration until you know how it affects you.

  • Talk to your doctor before stopping Keppra. Stopping it too abruptly can cause seizures due to withdrawals.

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Disclaimer

Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.

However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.

It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.

Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.

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