Levetiracetam (Keppra, UCB Pharma)
Levetiracetam (Keppra) was introduced in 2000. It is chemically based upon a drug called piracetam, which is used in Europe to improve cognition. Piracetam and levetiracetam probably do not improve cognition to any significant extent, but at least levetiracetam appears to have minimal deleterious effects on thinking. Levetiracetam is approved as an add-on medicine for partial seizures, including partial seizures with secondary generalization.
Experience is suggesting that it may have broad-spectrum action against all seizure types. The initial dose of 1,000 mg daily (500 mg twice a day), may be a therapeutic dosage for some. This allows rapid titration to efficacy. Levetiracetam is not metabolized in the liver and it has very few drug interactions. In most cases, the dug appears to be quite effective with a low incidence of significant side effects.
Summary Data for Levetiracetam
Pill sizes:
250 mg (blue tab, scored)
500 mg (yellow tab, scored)
750 mg (orange tab, scored)
Liquid for oral: none.
Injectable: none.
Typical adult dose
Manufacturer recommends 1,000 mg divided into two doses. This may be an effective dose right from the start. In individuals who are sensitive to medicine side effects, I split the capsules and begin with 500 mg per day in two divided doses. Typical adult maintenance dose is 1,000 - 3,000 mg/d in two divided doses.
Typical pediatric dose: not established.
Metabolism: mainly processed in the kidney, does not involve the liver.
Half-life: 6 - 8 hours, longer with kidney dysfunction.
Serum levels: unknown.
Pregnancy: Category C - can cause birth defects in animals, unknown in humans.
Drugs that raise LVT levels: None known.
Drugs that lower LVT levels: None known.
LVT increases effects of: None known.
LVT decreases effects of other drugs: None known. Does not affect oral contraceptives.
Dangerous Side Effects
Rare psychiatric side effects, such as hallucinations, delusions, that resolve within 1-2 weeks after stopping drugs. Since Keppra is a new drug, other rare serious side effects might emerge.
Common Side Effects
Usually few or no side effects, but can have sleepiness, fatigue, dizziness, unsteadiness, headache.
Other Side Effects
Behavior change, anxiety, rare decrease of red blood cells.