Levetiracetam

How to take:

Take levetiracetam exactly as your health care provider prescribes it. Do not change your dose without talking to your provider first. Stopping a seizure medicine suddenly can cause seizures that will not stop (status epilepticus). 

• Check the number of tablets and the strength of pills you get from the pharmacy. If your provider changes the dose, the strength of pills may be different. 
• Levetiracetam is usually taken twice a day, about 12 hours apart. 
• Swallow the tablets whole. They may have a bitter taste when the pill is crushed.  
• People who have trouble swallowing the pills whole can break the tablets in half, mix the tablet with food, or use the liquid form. 
• It can be taken with or without food, but it's best to take it the same way every day. 
• For the liquid form, always check the bottle for the amount to take and the strength. Levetiracetam liquid comes as 100 mg in every ml. 
  • Shake the bottle well before measuring a dose. 
  • Always use an accurate measuring spoon or syringe to make sure the amount is correct. Do not use a regular teaspoon. 
• Take only the amount that your provider tells you to take. If you take an extra dose, call your provider for advice. If you take a larger number of pills or overdose, call the poison control center (800-222-1222) or call your hospital emergency room. 

How to store:

• Store at room temperature (below 86^oF, 30^oC).
• Keep away from light and moisture.
• Keep all medicines out of reach of children. 

Taking the right amount of seizure medicine on time every day is the most important way to control seizures. Try these steps to help you remember when to take seizure medicine. 

• If you miss a dose, take it as soon as you remember it. If it is almost time for the next dose, skip the missed dose and go back to your usual schedule. 
• Avoid taking 2 doses at the same time or taking extra doses.
• If you are not sure about what to do, call your health care provider's office for advice. Do your best to follow their directions. 
• To avoid missed doses, use a pillbox or set an alarm on your watch or phone. 
• Send reminders to yourself with an online seizure diary or text message system like Texting 4 Control.
• Ask your pharmacist to prefill the medicine in blisterpaks.
• Write down any missed doses in your seizure calendar. Share this with your health care provider at each visit. 

Brain cells normally talk to each other using electrical signals and chemicals. Seizures can happen when the brain cells are not working or firing normally or working faster than normal. Most seizure medicines slow down these electrical discharges to stop seizures. 

• Levetiracetam works differently from most seizure medicines. It joins with a protein (called SV2A) that is involved with the release of certain chemicals called neurotransmitters in the brain. The exact way that these actions lead to decreased seizures is not fully known. 

How the body absorbs, digests, and breaks down or gets rid of a medicine is called metabolism. The way the body metabolizes a medicine affects how often it must be taken. This process can also affect if it will interact with other medicines. If a person has liver or kidney problems, a person's metabolism may be affected. 

Some important points about levetiracetam:

• The tablets and liquid take the same amount of time to be absorbed.
• Taking levetiracetam with food may slow down the time it takes for the body to absorb the drug by about 1 hour. 
• The highest blood levels are reached in 1 to 2 hours after taking a dose of this medicine. 
• The liver does not affect how levetiracetam works in the body. 
• The body gets rid of the drug through the kidneys. This may affect how much levetiracetam a person with kidney problems takes and how often they take it.  

Not all seizure medicines work for everyone. Your health care provider may try a series of seizure medicines or combination of medicines to find one that works best for you. 

• In most studies of levetiracetam when given with other seizure medicines, 20 to 40% of people had at least a 50% decrease in their seizures. (This means that the number of seizures each month was at least cut in half.)
• Most people did not have many problems with side effects in these studies. 
• At least one study found that levetiracetam may be helpful when used alone in people with focal (partial) seizures.
• Since this medicine does not interact with other seizure medicines, it is easier to use with other seizure medicines.  

In the early tests of levetiracetam, people who took this medicine were only slightly more likely to stop the drug because of side effects than people taking a placebo (inactive drug).

Some side effects may include:

• Dizziness
• Headache
• Irritability
• Loss of strength and energy
• Mood and behavior changes 
• Sleepiness

Some tips:

• Some side effects are more likely to happen in the first month of taking the drug. Some may go away on their own.
• If you notice any of these problems, call your health care provider. Changing the amount or way the drug is taken may help. Do not stop taking levetiracetam or the way it is taken without your doctor's advice.
• Some people report that levetiracetam has had positive effects - such as feeling more alert, thinking clearer, and better concentration. It is hard to know whether these effects are from the medicine or from having less seizures.
• Avoid dangerous activities when first starting this medicine or if taking a larger dose, untill you see If you have any side effects.
• Long-term side effects of levetiracetam have not been reported.

Very few people have serious side effects from levetiracetam. It is important to be aware of possible reactions and what to do if they happen. 

• Read the package insert for more information.
• Call your provider's office right away if any of these problems occur.

Allergic reactions: Allergic reactions happen rarely, but can cause symptoms such as low blood pressure, hives, rash, breathing difficulties, and swelling. It can happen after the first dose or any time when taking levetiracetam. Since this can be life-threatening, if these symptoms occur, get immediate medical help.  

Coordination problems: A small number of people may have unsteady walking or coordination problems when taking levetiracetam. This medicine may also worsen coordination or walking problems that were present before starting the drug. Adjusting the dose of levetiracetam may help. 

Changes in behavior, mood, or thoughts: Levetiracetam may cause changes in behavior, mood, or thoughts. This has been seen more often in young children than in adults taking this medicine. The dose of levetiracetam may need to be lowered or stopped. Examples of changes seen include:

• Anger, aggression
• Decreased ability to cope with daily life
• Depression
• Excessive emotional reactions or frequent mood swings or changes
• Severe anxiety, agitation, or confused thoughts
• Thoughts of suicide

Severe skin reactions: Rare but serious skin reactions, such as Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported with levetiracetam. These conditions may start with a fever and flu-like symptoms. Then a rash develops. Ulcers or lesions of the mucous membranes may be seen and develop into painful blisters. 

• Report any fever or rash to a health care provider as this can be a life-threatening condition. 
• These types of skin reactions happen most commonly in the second or third week after starting the medicine, though it can happen at other times too.  

Suicidal thoughts and behavior:  In 2008, the Food and Drug Administration (FDA) reviewed data from drug studies that showed a possible relationship between many seizure medicines and suicidal thoughts and behavior. Together, these thoughts and behavior are called suicidality. According to the FDA’s Alert, among the patients with epilepsy in these drug studies, more had symptoms of suicidality than people taking a placebo or inactive substance - 3.5 of 1,000 people taking a seizure medicine had suicidality compared to 1 of 1,000 people taking a placebo.

• Taking seizure medicines may increase the risk of having suicidal thoughts or actions.
• Do not make any changes to the medicines without first talking to the prescribing health care provider.
• Pay close attention to any day-to-day changes in mood, behavior and actions. These changes can happen very quickly so it is important to be mindful of any sudden differences.
• Be aware of common warning signs that might be a signal for risk of suicide. Some of these are:
  • Talking or thinking about wanting to hurt yourself or end your life
  • Withdrawing from friends and family
  • Becoming depressed or having your depression get worse
  • Becoming preoccupied with death and dying
  • Giving away prized possessions
• Contact your health care provider before stopping any seizure meicine. This could possibly lead to worsening of seizure and mood. 

Often medicines may be used for more than one purpose. It is legal to prescribe medicines for "off-label uses" even though the FDA has not formally approved such use. 

• There are no specific reports of off-label use of levetiracetam. 

People should not take levetiracetam if they have had an allergic reaction to the drug or any of its inactive ingredients. 

People with kidney disorders need to be extra careful, however. Levetiracetam may be given at a lower dose to prevent build up to a high level.

Sometimes one kind of medicine changes the way another kind of medicine works in the body. Taking levetiracetam does not seem to cause this kind of problem.

• Levetiracetam does not affect the level of other medicines in the body, and other medicines do not affect levetiracetam.

• The dose of levetiracetam used in children is based on their weight and age. It is usually started at a low dose and may be increased slowly to limit side effects. 
• This medicine is usually given in two doses about 12 hours apart. 
• Children's bodies handle medicines differently than teenagers and adults. The dose in a young child may be different and will need to be adjusted as they get older. 
• See the package insert for details on how to start a child on levetiracetam and the recommended dose for their age and weight. 

Effect of seizure medicines during pregnancy: In the United States, the FDA assigns each medication to a Pregnancy Category according to whether it has been proven to be harmful in pregnancy. Levetiracetam is listed in Pregnancy Category C. This means that caution is advised, but the benefits of the medicine may outweigh the potential risks.

• Studies in animals show possible harmful effects of levetiracetam to the developing fetus. Yet this needs to be studied in humans as more women use the drug.
• Talk to your health care providers if you are pregnant or plan to become pregnant.
• The risk of birth defects is generally higher in children of women who:
  • Take more than one seizure medicine at the same time 
  • Have a family history of birth defects

All women who are capable of becoming pregnant should take at least 0.4 mg (400 mcg) each day of the vitamin called folic acid (also called folate). This vitamin is thought to help prevent birth defects affecting the brain and spinal cord, called neural tube defects. The most common of these is known as spina bifida.  

• Women at high risk of having a child with a birth defect (such as those with a birth defect in a previous pregnancy or taking certain seizure medicines) may be asked to take 4 mg (4000 mcg) daily before and during pregnancy. 
• Talk to your health care provider about using folic acid and how much to take.
• Start taking this vitamin before you become pregnant. 

If you were taking levetiracetam while pregnant, consider enrolling in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334 (www.aedpregnancyregistry.org).

Seizures during pregnancy: Some women may have more seizures during pregnancy, because of hormone changes and how seizure medicine is handled by your body. 

• Talk to your health care provider before pregnancy about seizures and if medicine changes may be needed.
• Know when to check blood levels of medicine during and after pregnancy.
• The dose of seizure medicine may need to be adjusted during and after pregnancy. 

Breastfeeding: Low levels of levetiracetam have been found in breast milk when normal doses of the drug are given. This would not be expected to cause problems in a baby, especially those over 2 months old. Levetiracetam could affect a woman's supply of breast milk. 

• Women who wish to breastfeed should talk to their doctor about the best medicine to use during pregnancy and when breastfeeding. 
• If you choose to breastfeed, check the baby for drowsiness and keep track of their weight gain and development, especially if you are taking more than one seizure medicine. 
• Talk to your health care team about any concerns that arise and if you have any problems with breastfeeding. 

Contraception: Levetiracetam does not interfere with hormonal birth control. 

Levetiracetam is commonly prescribed for people over 65.  When people are older than 65 or 70, their kidneys usually don't work as well as before. The kidneys are responsible for removing levetiracetam from the body, so it stays in the body longer if the kidneys aren't working normally. 

• A very low dose of levetiracetam may need to be used when starting it in older adults. The dose of medicine would then be increased more slowly.
• Sometimes a person may be asked to take levetiracetam just once a day. 
• Seniors may be more sensitive to the side effects of this medicine.
• Common side effects like sleepiness, dizziness, or loss of strength, may be worse when taking levetiracetam.
• Older adults may be at greater risk of injury from falls or other accidents resulting from these problems.
• Levetiracetam does not interact with other medicines commonly used by older adults. 

The best amount is any seizure medicine is the amount that control seizures without causing bothersome side effects. This depends on many factors, which are different for every individual.

• The approved dose range of levetiracetam is between 1,000 and 3,000 mg daily. The medicine is usually started at lower doses and increased over a couple weeks. 
• Some people may be given higher doses, depending on their individual situation.
• See the package insert for doses used in children. 

In the United States, companies that manufacture medicines are required to publish certain kinds of information about each product. This document is commonly known as a “package insert” because it is usually included with each package of the medicine.

You can also read these documents (also called "prescribing information") online. The U.S. package insert for Keppra (levetiracetam) is found at:

• http://www.keppraxr.com/includes/pdf/Keppra_Injection_PI.pdf

Some of the information may differ in other countries.

Learn how to read a package insert here.