Levetiracetam: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on July 25, 2023.

1. How it works

• Levetiracetam is an anticonvulsant that may be used for the treatment of certain types of epilepsy.
• 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.
• Levetiracetam belongs to the class of medicines known as anticonvulsants.

2. Upsides

• Used in combination with other anticonvulsants for the treatment of partial onset, myoclonic, or generalized tonic-clonic seizures. May also be used for some other seizure types.
• Levetiracetam is approved to treat adults and children aged at least one month with partial onset seizures. However, the Spritam brand should not be used in children younger than four years or who weigh less than 44 pounds (20kg).
• Levetiracetam is approved to treat adults and children at least six with tonic-clonic seizures and myoclonic seizures in adults and children aged at least 12 years.
• Does not require monitoring of blood concentrations.
• Available as oral tablets (both immediate-release and extended-release), oral solution, and in an injectable form. All formulations are bioequivalent.
• Usually taken once or twice daily.
• Can be taken with or without food.
• Generic levetiracetam is available.

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, co-ordination 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 levetiracetam.
• As with other antiepileptics, levetiracetam may increase the risk of suicidal thoughts or behavior; monitor for worsening depression or mood changes. Levetiracetam may also cause behavioral problems such as aggression, anxiety, irritability, and nervousness; talk to your doctor if you experience any changes in your mood.
• Dosage may need reducing in people with kidney disease.
• Needs to be discontinued slowly over several weeks to minimize the potential for rebound seizures, unless a rapid withdrawal is justified.
• May not be suitable for everybody including those with kidney disease, with a history of mental health problems, and taking certain medications (such as propoxyphene, buprenorphine, and sedating antihistamines). Generally, less likely than some other anticonvulsants to interact with other medications.
• In children aged 1 month to 4 years, levetiracetam has been associated with an increase in blood pressure.
• Alcohol may worsen the side effects of levetiracetam such as drowsiness and dizziness.

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

Levetiracetam is an anticonvulsant that is used in conjunction with other medications for the treatment of certain types of seizures. It may cause drowsiness but interactions with other medications are less common than with some other anticonvulsants.

5. Tips

• Oral tablets and solutions may be given with or without food.
• Take exactly as directed. Do not increase or decrease the dose without your doctor's advice.
• If you are taking levetiracetam solution, use the dosing syringe provided or 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.
• Dissolvable tablets should be removed from their foil packet with dry hands and then placed on the tongue. The tablet should be left to dissolve without swallowing with a sip of liquid (should take about 30 seconds).
• 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. Levetiracetam may also cause aggression, anxiety, depression, and irritability.
• Levetiracetam may cause drowsiness and affect your ability to drive or operate machinery. Avoid alcohol.
• Talk to your doctor immediately if you develop a rash while taking levetiracetam.

6. Response and effectiveness

• Levetiracetam is rapidly and almost completely absorbed after oral administration. It reduces seizure frequency by about half in 20% to 40% of all people who take it.
• The dosage for levetiracetam tablets and the injection is the same.

7. Interactions

Medicines that interact with levetiracetam may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with levetiracetam. 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 levetiracetam 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 levetiracetam.

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

References

• Levetiracetam. Revised 07/2023. Quallent Pharmaceuticals Health LLC​. https://www.drugs.com/pro/levetiracetam.html

Further information

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

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

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