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Keppra: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 26, 2022.

1. How it works

  • Keppra is a brand (trade) name for levetiracetam which may be used for the treatment of certain types of seizures.
  • Experts aren't sure exactly how levetiracetam works but suggest it dampens down excessive nerve firing and reduces seizure propagation, possibly through an impact on pathways involving calcium, glycine, and GABA.
  • Keppra belongs to the class of medicines known as anticonvulsants (also called antiepileptics).

2. Upsides

  • Used in combination with other anticonvulsants for the treatment of partial-onset seizures in adults and children over the age of 1 month, for generalized tonic-clonic seizures in adults and children over the age of 6, and the treatment of myoclonic seizures in adults and adolescents over the age of 12.
  • Does not require monitoring of blood concentrations.
  • Available as oral tablets, extended-release tablets (Keppra-XR), and as an oral solution. The oral solution should be prescribed for children with a body weight less than or equal to 20kg. The oral solution or tablets may be given to children weighing more than 20kg. Only calibrated measures (not household spoons) should be used to measure the oral solution.
  • Usually taken once or twice daily.
  • Available as 250mg, 500mg, 750mg, and 1000mg tablets and a 100mg/mL oral solution.
  • The usual initial dosage in adults 16 years and older is 500mg twice a day. The dosage may be increased every two weeks as needed to a maximum of 1500mg twice a day.
  • Keppra is available as a generic under the name levetiracetam.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Drowsiness which may affect your ability to drive or operate machinery. Avoid alcohol.
  • Aggression, nasal congestion, headache, decreased appetite, infection, dizziness, pain, sore throat, depression, nervousness, and fatigue are reasonably common side effects. Hematologic abnormalities, coordination difficulties, and serious dermatological reactions (for example, Stevens-Johnson syndrome [SJS] and toxic epidermal necrolysis [TEN]) have also been reported.
  • Young children are more likely than adults to experience behavioral abnormalities (eg, overactivity or agitation) or psychotic symptoms as well as other side effects such as a decreased appetite, increased blood pressure, or nasal congestion while taking Keppra.
  • As with other antiepileptics, Keppra may increase the risk of suicidal thoughts or behavior. Monitor for worsening depression or mood changes. Keppra may also cause behavioral problems such as aggression, anxiety, irritability, and nervousness; advise people taking Keppra to monitor their mood.
  • The dosage of Keppra needs to be reduced in people with kidney disease.
  • May not be suitable for some people including those with kidney disease, with a history of mental health problems, who are pregnant or breastfeeding.
  • May interact with some medications, such as propoxyphene, buprenorphine, and sedating antihistamines; however, generally, less likely to interact with other medications than some other anticonvulsants.
  • In children aged 1 month to 4 years, Keppra has been associated with an increase in blood pressure.
  • Alcohol may worsen the side effects of Keppra such as drowsiness and dizziness.
  • Withdrawal of Keppra may cause an increase in seizure frequency. Keppra should be tapered off slowly on discontinuation.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

  • Keppra is an anticonvulsant that is used in conjunction with other medications for the treatment of certain types of seizures. It may cause drowsiness but it is less likely than some other anticonvulsants to interact with other medications.

5. Tips

  • Keppra may be given with or without food.
  • Take exactly as directed. Do not increase or decrease the dosage without your doctor's advice.
  • If you are giving Keppra solution to a child or taking it yourself, use the dosing syringe provided or use a properly calibrated liquid measure (these can be bought from a drug store). Do not use a kitchen teaspoon.
  • Extended-release tablets should be swallowed whole. Do not crush, chew or break.
  • When it comes time to discontinue Keppra, your doctor will advise you on a slowly tapering dosing schedule. Do not just stop it suddenly unless your doctor has advised you that a rapid withdrawal is justified.
  • Talk to your doctor if you feel like your mood has changed for the worse or if you have any thoughts about suicide or self-harm. Keppra may also cause aggression, anxiety, depression, and irritability.
  • Keppra may cause drowsiness or coordination difficulties and affect your ability to drive or operate machinery. Avoid alcohol.
  • Talk to your doctor immediately if you develop a rash or any other worrying side effects while taking Keppra.

6. Response and effectiveness

  • Keppra is rapidly and almost completely absorbed after oral administration. It reduces seizure frequency by about half in 20 to 40% of people who take it.
  • Keppra tablets and the oral solution are absorbed to the same extent.

7. Interactions

Medicines that interact with Keppra may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Keppra. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Keppra include:

  • antidepressants, such as SSRIs (eg, escitalopram, fluoxetine) and monoamine oxidase inhibitors, such as isocarboxazid, selegiline, or tranylcypromine
  • antiepileptics, such as carbamazepine and phenytoin
  • benzodiazepines, such as diazepam, oxazepam, and temazepam
  • brivaracetam
  • buprenorphine
  • clozapine
  • mefloquine
  • methotrexate
  • methotrimeprazine
  • minocycline
  • metoclopramide
  • opioids, such as methadone, oxycodone, morphine, or codeine
  • sedatives, or any medication that causes sedation, such as sedating antihistamines, sleeping pills, or muscle relaxants
  • tramadol.

Alcohol may enhance the sedative effects of Keppra.

Note that this list is not all-inclusive and includes only common medications that may interact with Keppra. You should refer to the prescribing information for Keppra for a complete list of interactions.


Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Keppra only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2023 Revision date: May 25, 2022.