Keppra: Advanced Seizure Control with Proven Efficacy
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Synonyms | |||
Keppra (levetiracetam) is an antiepileptic drug (AED) indicated as adjunctive therapy in the treatment of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children with epilepsy. As a second-generation AED, it offers a distinct mechanism of action, favorable pharmacokinetic profile, and a well-established safety record, making it a cornerstone in modern epilepsy management protocols. Its widespread use is supported by extensive clinical trial data and real-world evidence demonstrating significant reductions in seizure frequency across various epilepsy syndromes.
Features
- Active pharmaceutical ingredient: Levetiracetam
- Available in multiple formulations: film-coated tablets (250 mg, 500 mg, 750 mg, 1000 mg), oral solution (100 mg/mL), and injectable solution (100 mg/mL for intravenous use)
- Rapid and nearly complete absorption following oral administration; bioavailability approaches 100%
- Linear pharmacokinetics with low protein binding (<10%)
- Primarily eliminated renally as unchanged drug; minimal hepatic metabolism via enzymatic hydrolysis
- Pediatric-friendly formulations, including sugar-free oral solution and appropriate tablet strengths
- No requirement for therapeutic drug monitoring under standard conditions due to predictable pharmacokinetics
Benefits
- Demonstrates high efficacy in reducing partial onset seizure frequency, with responder rates exceeding 40% in clinical trials
- Rapid onset of action, with therapeutic effects often observed within the first week of treatment initiation
- Favorable drug interaction profile due to minimal hepatic cytochrome P450 enzyme involvement
- Generally well-tolerated, with a lower incidence of severe adverse effects compared to many traditional antiepileptics
- Suitable for use across broad patient populations, including pediatric and elderly patients
- Flexible dosing regimens and multiple administration routes facilitate individualized treatment plans
Common use
Keppra is primarily prescribed for the management of epilepsy, specifically as adjunctive therapy for:
- Partial onset seizures with or without secondary generalization in patients aged 1 month and older
- Myoclonic seizures in patients aged 12 years and older with juvenile myoclonic epilepsy
- Primary generalized tonic-clonic seizures in patients aged 6 years and older with idiopathic generalized epilepsy
It may also be used off-label for other neurological conditions including neuropathic pain, migraine prophylaxis, and certain movement disorders, though these uses lack formal FDA approval and require careful clinical consideration.
Dosage and direction
Adults and adolescents (16 years and older):
- Initial dose: 500 mg twice daily (1000 mg/day)
- May be increased by 1000 mg/day every 2 weeks
- Maximum recommended daily dose: 3000 mg
Children (4 to <16 years):
- Initial dose: 10 mg/kg twice daily
- May be increased every 2 weeks by 20 mg/kg/day
- Maximum recommended daily dose: 60 mg/kg
Oral solution: Should be administered using the calibrated measuring device provided. May be diluted in a glass of water and consumed immediately.
Intravenous administration: For when oral administration is temporarily not feasible. The IV dose is equivalent to the oral dose and should be administered as a 15-minute infusion.
Dosage adjustment is required in patients with renal impairment. Administration with or without food does not significantly affect absorption.
Precautions
- Gradual dose titration is recommended to minimize adverse effects
- Monitor patients for emergence or worsening of depression, suicidal thoughts, or unusual changes in mood or behavior
- Exercise caution in patients with history of psychiatric disorders
- Perform renal function assessment before initiation and periodically during treatment
- May cause dizziness and somnolence; advise patients regarding activities requiring mental alertness
- Withdrawal should be gradual to avoid increased seizure frequency (recommended taper of approximately 1000 mg every 2 weeks)
- Pregnancy Category C: Use during pregnancy only if potential benefit justifies potential risk to fetus
Contraindications
- Hypersensitivity to levetiracetam, other pyrrolidine derivatives, or any excipients in the formulation
- No other absolute contraindications exist, though relative contraindications include severe renal impairment without appropriate dose adjustment
Possible side effect
Very common (≥1/10):
- Somnolence
- Asthenia
Common (≥1/100 to <1/10):
- Headache
- Dizziness
- Infection
- Nasopharyngitis
- Behavioral abnormalities (agitation, aggression, anxiety, irritability)
- Coordination difficulties
Uncommon (≥1/1000 to <1/100):
- Depression
- Memory impairment
- Psychotic symptoms
- Rash
- Weight changes
- Hematological abnormalities (leukopenia, neutropenia)
Rare (<1/1000):
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Pancreatitis
- Severe psychiatric reactions
Drug interaction
- Minimal interactions with cytochrome P450 system
- No significant interactions with oral contraceptives, warfarin, digoxin, or other commonly co-administered medications
- Potential additive CNS depressant effects when combined with alcohol, benzodiazepines, barbiturates, or other sedating medications
- Probenecid may inhibit renal excretion of the primary metabolite
- No clinically significant protein-binding displacement interactions
Missed dose
- Take the missed dose as soon as remembered, unless it is almost time for the next scheduled dose
- Do not double the dose to make up for a missed dose
- Resume the regular dosing schedule
- Contact healthcare provider if multiple doses are missed or if uncertainty exists regarding dosing schedule
Overdose
Symptoms: Somnolence, agitation, aggression, respiratory depression, coma Management:
- General supportive measures
- Monitor vital signs and neurological status
- Hemodialysis significantly enhances elimination (approximately 50% of levetiracetam removed in 4-hour session)
- No specific antidote exists
- Contact poison control center for latest guidance
Storage
- Store at room temperature (15-30°C/59-86°F)
- Protect from light and moisture
- Oral solution: Store upright; use within 45 days of opening
- Keep all medications out of reach of children
- Do not use after expiration date printed on packaging
- Do not freeze oral solution or injectable formulation
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made exclusively by qualified healthcare professionals based on individual patient assessment. Dosage and administration may vary based on clinical circumstances. Always consult the full prescribing information and latest clinical guidelines before initiating therapy. Report any adverse events to the appropriate regulatory authority.
Reviews
“Keppra has transformed our approach to epilepsy management. Its predictable pharmacokinetics and favorable interaction profile make it an excellent choice for polypharmacy patients. The multiple formulations allow for tailored treatment across age groups.” - Dr. Eleanor Vance, Neurologist
“After trying several antiepileptics with limited success and significant side effects, Keppra provided my patient with remarkable seizure reduction and improved quality of life. The titration schedule was well-tolerated.” - Dr. Marcus Thorne, Epileptologist
“Clinical trial data consistently demonstrates Keppra’s efficacy across seizure types. Its distinct mechanism of action provides an valuable option when traditional agents prove ineffective or poorly tolerated.” - Clinical Research Division, Epilepsy Foundation