Levetiracetam

About Levetiracetam

Levetiracetam is an anticonvulsant; MedlinePlus says it works by decreasing abnormal excitement in the brain. Keppra tablets and oral solution and their generics are labeled for partial-onset seizures from 1 month of age, alone or with other seizure medicines, and as an add-on for myoclonic seizures in juvenile myoclonic epilepsy from age 12 and for primary generalized tonic-clonic seizures in idiopathic generalized epilepsy from age 6. Keppra XR is labeled for partial-onset seizures from age 12. Spritam, a tablet that breaks up in the mouth with a sip of liquid, carries the same three uses, though for partial-onset seizures only from age 4 and above 20 kg. Adults usually start at 500 mg twice a day (or 1,000 mg of Keppra XR once a day), rising by 1,000 mg a day every two weeks to no more than 3,000 mg a day; children are dosed by weight, and those weighing 20 kg or less use the oral solution. Doses are lowered for reduced kidney function.

Levetiracetam has no boxed warning. It can cause behavior changes, such as aggression, agitation, anger, anxiety, depression, hostility and irritability, and psychotic symptoms, and like all antiepileptic drugs it raises the risk of suicidal thoughts or behavior, so patients are watched for psychiatric symptoms. Other warnings cover sleepiness, tiredness and poor coordination, so people should not drive until they know how it affects them; anaphylaxis and angioedema; serious skin reactions; DRESS, a reaction with fever, rash and swollen lymph nodes that can injure organs, which the FDA warned about in November 2023 and labels added in March 2024; changes in blood counts; and raised diastolic blood pressure in children 1 month to under 4 years. Anyone allergic to it must not take it. Sleepiness, weakness, infections and dizziness are the most common side effects in adults; tiredness, aggression, a stuffy nose, decreased appetite and irritability in children.

Stopping suddenly raises the risk of more frequent seizures and status epilepticus, so the dose is lowered gradually. Levetiracetam levels can fall during pregnancy, especially in the third trimester, so seizure control is watched closely; long experience in pregnancy has not identified a drug-associated risk of major birth defects or miscarriage, and it passes into breast milk. Keppra XR tablets are swallowed whole, and something that looks like a swollen piece of tablet may appear in the stool. Spritam must not be swallowed whole; since June 2025 it may also be given through a feeding tube. Elepsia XR extended-release tablets and the 750 and 1,000 mg Spritam tablets have been discontinued.

Taking Levetiracetam

How to take it

Tablets and solution twice a day, extended-release tablets once a day, with or without food. Swallow regular and extended-release tablets whole, and measure the solution with a calibrated device, not a household spoon. Place Spritam on the tongue with a dry hand and a sip of liquid, swallowing only after it breaks up, or disperse it in a little liquid and drink it all.

If you miss a dose

If only a few hours have passed, take it as soon as you remember; if the next dose is nearly due, skip it. Never take a double dose.

Storage

At room temperature, tightly closed, away from light, heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

In label studies it did not change levels of other seizure medicines, digoxin, warfarin or a birth control pill, and no dose change is advised when it is taken with other seizure medicines. It can cause sleepiness and unsteadiness, so do not drive until you know how it affects you.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Levetiracetam differs from pharmacy to pharmacy

Generic levetiracetam tablets, solution and extended-release tablets all have many makers, so a quote is priced as a brand mainly when the prescription names Keppra or Keppra XR and blocks substitution. Adult doses range from 1,000 to 3,000 mg a day, so the tablet count depends on the strengths written, and the solution is dispensed by volume.

Spritam has no generic, so it is priced as a brand, and it cannot be swapped at the counter for ordinary tablets or the solution.

Ways to pay less for Levetiracetam without insurance

• Ask for generic levetiracetam, and check that the prescription does not name Keppra or Keppra XR only.
• Ask for quotes on your dose in different tablet strengths, such as one 1,000 mg or two 500 mg tablets, and ask the prescriber which to write.
• Once your dose is settled, ask for a ninety-day supply and whether levetiracetam is on the pharmacy’s flat-price generic list.
• If Spritam is prescribed, ask the prescriber whether the oral solution or regular tablets would suit you, or ask the maker about a savings program for cash payers.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Levetiracetam

1. 1.Which mood or behavior changes should I report right away?
2. 2.Is my dose adjusted for my kidney function?
3. 3.Is it normal to see tablet pieces in my stool?
4. 4.How do I measure my child’s oral solution dose?

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