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Keppra XR Side Effects

Generic Name: levetiracetam

Note: This page contains information about the side effects of levetiracetam. Some of the dosage forms included on this document may not apply to the brand name Keppra XR.

Not all side effects for Keppra XR may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to levetiracetam: oral solution, oral tablet, oral tablet extended release

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by levetiracetam (the active ingredient contained in Keppra XR). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking levetiracetam:

More common
  • Aggressive or angry
  • anxiety
  • change in personality
  • chills
  • cough or hoarseness
  • crying
  • depersonalization
  • diarrhea
  • dry mouth
  • euphoria
  • fever
  • general feeling of discomfort or illness
  • headache
  • hyperventilation
  • irregular heartbeats
  • irritability
  • joint pain
  • loss of appetite
  • lower back or side pain
  • mental depression
  • muscle aches and pains
  • nausea
  • painful or difficult urination
  • paranoia
  • quick to react or overreact emotionally
  • rapidly changing moods
  • restlessness
  • shaking
  • shivering
  • shortness of breath
  • sleepiness or unusual drowsiness
  • sore throat
  • stuffy or runny nose
  • sweating
  • trouble sleeping
  • unusual tiredness or weakness
  • vomiting
Less common
  • Bloody nose
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • clumsiness or unsteadiness
  • discouragement
  • dizziness or lightheadedness
  • double vision
  • earache
  • feeling of constant movement of self or surroundings
  • feeling sad or empty
  • increase in body movements
  • loss of bladder control
  • loss of memory
  • mood or mental changes
  • outburst of anger
  • pain or tenderness around the eyes and cheekbones
  • problems with memory
  • redness or swelling in the ear
  • seizures
  • sensation of spinning
  • shakiness and unsteady walk
  • shakiness in the legs, arms, hands, or feet
  • tightness of the chest
  • tiredness
  • trembling or shaking of the hands or feet
  • trouble concentrating
  • unsteadiness, trembling, or other problems with muscle control or coordination
Incidence not known
  • Attempts at killing oneself
  • being forgetful
  • bleeding gums
  • blistering, peeling, or loosening of the skin
  • bloating
  • blood in the urine or stools
  • bloody, black, or tarry stools
  • blurred vision
  • changes in vision
  • chest pain
  • constipation
  • dark urine
  • difficulty with moving
  • fast heartbeat
  • general feeling of tiredness or weakness
  • high fever
  • increase in body movements
  • indigestion
  • itching
  • light-colored stools
  • muscle pains or stiffness
  • painful or difficult urination
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • pale skin
  • pinpoint red spots on the skin
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • sores, ulcers, or white spots on the lips or in the mouth
  • stomach pain, continuing
  • swollen glands
  • swollen joints
  • thoughts or attempts at killing oneself
  • trouble with balance
  • twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
  • uncontrolled jerking or twisting movements of the hands, arms, or legs
  • uncontrolled movements of the lips, tongue, or cheeks
  • unexplained bleeding or bruising
  • unusual bleeding or bruising
  • upper right abdominal or stomach pain
  • weight loss
  • yellow eyes or skin

Some of the side effects that can occur with levetiracetam may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Loss of strength or energy
  • muscle pain or weakness
  • pain
  • tender, swollen glands in the neck
  • trouble swallowing
  • unusual weak feeling
  • voice changes
Less common
  • Body aches or pain
  • burning, dry, or itching eyes
  • change in the color of the skin
  • congestion
  • cough increased
  • rash
  • sneezing
Incidence not known
  • Hair loss or thinning of the hair
  • skin rash, encrusted, scaly, and oozing

For Healthcare Professionals

Applies to levetiracetam: intravenous solution, oral solution, oral tablet, oral tablet extended release

Nervous system

Nervous system side effects have included somnolence (up to 15%), dizziness (9%), vertigo (up to 5%), depression (4%), nervousness (4%), ataxia (3%), amnesia (2%), anxiety (2%), emotional lability (2%), hostility (2%), and paresthesia (2%). A case of levetiracetam-induced parkinsonism has also been reported.

Somnolence (8%) and dizziness (5%) have been reported with extended release tablets.

Postmarketing reports: Choreoathetosis, dyskinesia[Ref]


Respiratory side effects have included pharyngitis (up to 7%), rhinitis (4%), increased cough (2%), and sinusitis (2%).

Nasopharyngitis (7%) has been reported with extended release tablets.[Ref]


Psychiatric side effects such as depression (up to 5.7%) including suicidal depression (up to 0.7%), irritability (6%), and mood swings (5%) have been reported.

In some patients experiencing primary generalized tonic-clonic seizures, levetiracetam (the active ingredient contained in Keppra XR) caused behavioral abnormalities. Nonpsychotic mood disorders (reported as anger, apathy, depression, altered mood, mood swings, negativism, suicidal ideation, and tearfulness) occurred in 12.7% of levetiracetam-treated patients. One patient experienced suicidal ideation. Another patient experienced delusional behavior that required the lowering of the dose of levetiracetam.

Irritability (7%) has been reported with extended release tablets.[Ref]

Slower titration should be considered in patients at a higher risk of discontinuing levetiracetam for behavioral reasons.[Ref]


A multicenter, double-blind, placebo controlled trial (n=517) has reported that 10.1% of patients treated with levetiracetam (the active ingredient contained in Keppra XR) had adverse psychiatric events. A significant association was reported with previous psychiatric history, history of febrile convulsions, and history of status epilepticus. Concomitant therapy with lamotrigine was reported to have had a protective effect. Psychiatric adverse events were not related to the titration schedule of levetiracetam. Certain patients seem to be more vulnerable biologically.[Ref]

Gastrointestinal side effects have included anorexia (3%), pancreatitis, and diarrhea.

Nausea (5%) has been reported with extended release tablets.[Ref]


Ocular side effects have included diplopia (2%).[Ref]


One possibly significant decreased WBC count occurred in every 3.2% of treated patients. One possibly significant decreased neutrophil count occurred in every 2.4% of treated patients.[Ref]

Hematologic side effects have included leukopenia, neutropenia, pancytopenia (with bone marrow suppression identified in some of these cases), and thrombocytopenia. Minor, but statistically significant decreases in total mean RBC count (0.03 x 1,000,000/mm2), mean hemoglobin (0.09 g/dL), and mean hematocrit (0.38%) have also been reported.[Ref]


Recovery from alopecia was reported in the majority of the cases where levetiracetam (the active ingredient contained in Keppra XR) was discontinued.[Ref]

Dermatologic side effects have included Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in both children and adults and alopecia.[Ref]


Hepatic side effects including abnormal liver function tests, hepatitis, and hepatic failure have been reported during postmarketing surveillance.[Ref]


Musculoskeletal side effects including neck pain (8%) have been reported.[Ref]


1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

2. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. Available from: URL:" ([2006]):

3. "Product Information. Keppra (levetiracetam)" UCB Pharma Inc, Smyrna, GA.

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