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Levetiracetam (Keppra) 💊
Related Subjects: |Status Epilepticus (Epilepsy) |Coma management |Lorazepam |Phenytoin |Levetiracetam |Epilepsy - General Management |First Seizure |Epilepsy in Pregnancy |Febrile seizures
📖 About
- Check BNF entry here for up-to-date dosing and monitoring guidance.
- Broad-spectrum anticonvulsant with a favourable interaction profile.
- Mechanism not fully understood – binds to synaptic vesicle protein SV2A, modulating neurotransmitter release.
🧾 Indications
- Monotherapy for partial seizures.
- Adjunctive therapy for partial, myoclonic, and generalised tonic–clonic seizures.
- Status epilepticus (IV, unlicensed but widely used in UK practice).
💊 Dose (Adults)
- Epilepsy (PO): – Start: 250 mg once daily for 1–2 weeks. – Increase to 250 mg twice daily. – Titrate every 2–4 weeks up to usual maintenance: 1.5 g BD. – Max dose often 3 g/day (BNF). – Adjust for renal impairment.
- Status Epilepticus (IV, loading): – Consider 40–60 mg/kg IV infusion over 15 minutes (max 4500 mg). – Commonly 50 mg/kg used in UK hospitals. - Consider Oral Starting 500 mg PO twice daily (BD)
- Status Epilepticus (maintenance, renal adjusted): – eGFR 50–80 mL/min: 1000 mg BD. – eGFR 30–50 mL/min: 750 mg BD. – eGFR <30 mL/min: 500 mg BD. – Dialysis patients: 500 mg OD (with supplemental dose post-dialysis).
🔄 Interactions
- Minimal – no major CYP450 involvement.
- Safe choice when polypharmacy is a concern (elderly, oncology, transplant patients).
💥 Side Effects
- Neurological: dizziness, somnolence, ataxia, tremor, headache.
- Psychiatric: irritability, agitation, insomnia, mood changes (depression, rarely psychosis).
- Dermatological: rash, Stevens–Johnson syndrome (rare), DRESS syndrome.
- Haematological: leucopenia, anaemia (uncommon).
- Generally well tolerated compared with older AEDs.
🧪 Monitoring
- No routine blood monitoring required.
- Check renal function (dose adjustment needed).
- Monitor mood and behavioural side effects, especially in adolescents and young adults.
📚 References
- NICE BNF – Levetiracetam
- Royal Cornwall Hospitals NHS Trust – Status Epilepticus guideline
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