Antiseizure medications · Neurology
Levetiracetam
Keppra®(brand names vary by market)
No interactions, no levels, and sometimes a personality change.
Also: oral liquid, injection, modified release
Mechanism
Binds synaptic vesicle protein SV2A, modulating neurotransmitter release. A mechanism unlike any other antiseizure medication, and one reason its interaction profile is so quiet.
Indications
- Focal and generalised seizures
- Status epilepticus, as a second-line agent
- Seizure prophylaxis in selected acute settings
Formulations
Dosing concepts
Renal dosing
Largely renally cleared, so the dose falls with clearance and an extra dose is given after dialysis.
Intravenous switch
Oral and intravenous doses are equivalent milligram for milligram, which makes it easy to manage around a nil-by-mouth period.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~100%
- Half-life
- 6 to 8 h, longer in renal impairment
- Elimination
- renal: Mostly unchanged, with some plasma hydrolysis; no CYP involvement at all
- Protein binding
- <10%
Adverse effects
- Somnolence and fatiguecommon
- Irritability, aggression, mood changecommon & seriousThe characteristic problem with this drug; it can be marked and is often first noticed by family rather than the patient.
- Depression and suicidal ideationserious
- Dizzinesscommon
Contraindications & precautions
Contraindications
- Known hypersensitivity
Precautions
- Existing psychiatric illness
- Renal impairment
- Adolescents, in whom behavioural effects are prominent
Interactions
No curated interaction entries yet for this agent.
Monitoring
Seizure frequency
The endpoint
Mood and behaviour, asking a family member as well
The patient may not report it, and it is the main reason the drug is changed
Renal function
It sets the dose
Counselling points
- Take it at the same times daily and never stop it abruptly.
- Tell us if you or your family notice you becoming irritable, low, or unlike yourself. That is a known effect and there are alternatives.
- Do not drive until your seizures meet the legal requirements where you live.
Clinical pearls
- Its lack of interactions is why it has taken over the ward: in a patient on chemotherapy, anticoagulants or antiretrovirals, it is often the only sensible choice.
- Pyridoxine supplementation is sometimes used for the behavioural effects; the evidence is modest but the intervention is harmless and occasionally rescues the drug.
References & review
- Levetiracetam product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.