Levetiracetam: Uses, Dosage & Side Effects
A prescription anticonvulsant used to treat various types of epileptic seizures in adults and children
Levetiracetam is a prescription anticonvulsant (anti-epileptic) medication widely used to treat epilepsy in adults and children. It works through a unique mechanism by binding to synaptic vesicle protein 2A (SV2A) in the brain, modulating neurotransmitter release and reducing abnormal electrical activity that causes seizures. Levetiracetam is available under the brand name Keppra and numerous generic versions. It can be used as monotherapy (sole treatment) for focal seizures in adults and adolescents, and as add-on therapy for focal, myoclonic, and primary generalized tonic-clonic seizures. A distinctive advantage is its very low potential for drug interactions, near-complete oral bioavailability, and the availability of an intravenous formulation for patients who cannot take oral medication. Important safety considerations include behavioral and psychiatric side effects such as irritability, aggression, and mood changes. Never stop levetiracetam abruptly without medical supervision.
Quick Facts: Levetiracetam
Key Takeaways
- Levetiracetam is approved to treat focal (partial) seizures, myoclonic seizures in juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures. It can be used as monotherapy from age 16 and as add-on therapy from 1 month of age.
- It has a unique mechanism of action through SV2A binding, distinct from most other anti-epileptic drugs, and has near-complete oral bioavailability with minimal hepatic metabolism.
- Behavioral and psychiatric side effects — including irritability, aggression, anxiety, and depression — are the most clinically significant adverse effects and should be monitored closely, especially during the first weeks of treatment.
- Levetiracetam has an exceptionally low potential for drug interactions, making it a practical choice for patients on multiple medications.
- Never stop levetiracetam abruptly; the dose must be tapered gradually under medical supervision to avoid rebound seizures.
What Is Levetiracetam and What Is It Used For?
Levetiracetam is a prescription medication belonging to the anticonvulsant drug class. It was first approved by the European Medicines Agency (EMA) in 2000 and by the U.S. Food and Drug Administration (FDA) in 1999, initially under the brand name Keppra. It has since become one of the most widely prescribed anti-epileptic drugs globally, valued for its broad efficacy, favorable pharmacokinetic profile, and low drug interaction potential. Levetiracetam is listed on the World Health Organization (WHO) Model List of Essential Medicines, underscoring its importance in the global treatment of epilepsy.
Chemically, levetiracetam is the S-enantiomer of α-ethyl-2-oxo-1-pyrrolidine acetamide, a pyrrolidone derivative. Its mechanism of action is unique among anti-epileptic drugs: rather than targeting sodium channels, calcium channels, or GABA receptors (the primary targets of most older and many newer anti-epileptic medications), levetiracetam binds to synaptic vesicle protein 2A (SV2A) in the brain. SV2A is a glycoprotein found in the membranes of synaptic vesicles — the tiny compartments that store neurotransmitters at nerve endings. By binding to SV2A, levetiracetam modulates neurotransmitter release, particularly reducing excessive synchronization of neuronal firing that underlies seizure activity. This unique target is thought to explain both its broad-spectrum anticonvulsant activity and its relatively favorable side effect profile compared to many traditional anti-epileptic drugs.
Additionally, preclinical studies suggest that levetiracetam has neuroprotective properties and may inhibit the kindling process (a model for epilepsy progression), although the clinical significance of these findings remains under investigation. Unlike many other anticonvulsants, levetiracetam does not appear to have anxiolytic, analgesic, or sedative properties at therapeutic doses, which contributes to its favorable cognitive profile.
Monotherapy (Single Treatment)
Levetiracetam is approved as monotherapy (sole anti-epileptic drug) for the treatment of focal (partial) seizures with or without secondary generalization in adults and adolescents from 16 years of age who have been newly diagnosed with epilepsy. Focal seizures begin in one area of the brain and may or may not spread to affect both hemispheres (secondary generalization). When levetiracetam is used as monotherapy, large randomized controlled trials have demonstrated that it is non-inferior to immediate-release carbamazepine — long considered the gold standard for focal epilepsy — in achieving seizure freedom, while offering a simpler titration schedule and fewer drug interactions.
International guidelines from the International League Against Epilepsy (ILAE) and the National Institute for Health and Care Excellence (NICE) include levetiracetam as a first-line monotherapy option for focal epilepsy in adults. Its broad-spectrum efficacy, linear pharmacokinetics, minimal protein binding, and renal elimination make it a particularly practical first choice for newly diagnosed patients, including those with comorbid conditions or who take other medications for unrelated conditions.
Adjunctive (Add-On) Therapy
In addition to monotherapy, levetiracetam is widely approved as adjunctive therapy (add-on to other anti-epileptic drugs) for three major types of seizures:
- Focal (partial) seizures with or without secondary generalization in adults, adolescents, children, and infants from 1 month of age. This is the broadest indication and the most common use of levetiracetam worldwide.
- Myoclonic seizures in adults and adolescents from 12 years of age with juvenile myoclonic epilepsy (JME). Myoclonic seizures are sudden, brief involuntary jerks of muscles or muscle groups, commonly occurring shortly after waking. JME is one of the most common generalized epilepsy syndromes.
- Primary generalized tonic-clonic seizures in adults and adolescents from 12 years of age with idiopathic generalized epilepsy (genetic generalized epilepsy). These are the classic major seizures involving loss of consciousness, body stiffening (tonic phase), and rhythmic jerking (clonic phase).
Clinical trials across these indications have consistently demonstrated significant reductions in seizure frequency when levetiracetam is added to existing anti-epileptic therapy. In pivotal adjunctive therapy trials, levetiracetam at doses of 1000–3000 mg/day reduced focal seizure frequency by approximately 20–40% more than placebo, with a meaningful proportion of patients achieving seizure freedom.
Available Formulations
Levetiracetam is available in three formulations to accommodate different patient needs:
- Film-coated tablets: Available in strengths of 250 mg, 500 mg, 750 mg, and 1000 mg. The tablets have score lines but these are for ease of swallowing only, not for dividing into equal doses.
- Oral solution: 100 mg/ml concentration. This formulation is particularly suitable for infants, young children, and patients who have difficulty swallowing tablets. It allows precise weight-based dosing.
- Solution for infusion: 5 mg/ml concentration for intravenous administration. This is used when oral administration is temporarily not feasible (for example, during surgery, in critically ill patients, or in status epilepticus). The intravenous dose is bioequivalent to the oral dose.
All formulations are taken or administered twice daily — once in the morning and once in the evening, approximately 12 hours apart — with or without food. The oral bioavailability of levetiracetam is close to 100%, meaning that virtually all of the orally administered drug reaches the systemic circulation, making oral and intravenous dosing directly interchangeable at the same dose.
What Should You Know Before Taking Levetiracetam?
Contraindications
Levetiracetam must not be used if you have a known allergy (hypersensitivity) to levetiracetam, other pyrrolidone derivatives (such as piracetam), or any of the other ingredients in the formulation. Allergic reactions, while rare, can range from mild skin rash to severe anaphylaxis. If you have previously experienced an allergic reaction to any product containing levetiracetam, do not take this medication again. Always check with your pharmacist if you are uncertain whether any of your current medications contain levetiracetam to avoid accidental duplication.
Warnings and Precautions
A small but clinically significant proportion of patients taking levetiracetam experience behavioral and psychiatric adverse effects. These include irritability, aggression, agitation, hostility, anxiety, depression, personality changes, and in uncommon cases, psychotic symptoms and suicidal ideation. These effects are more likely during the first month of treatment or after dose increases. Patients, family members, and caregivers should be alert for any changes in mood, behavior, or personality and report them to the prescribing doctor immediately.
Talk to your doctor before taking levetiracetam if any of the following apply to you:
- Kidney problems: Levetiracetam is primarily eliminated through the kidneys. If you have impaired kidney function, your doctor will need to reduce the dose to prevent the drug from accumulating to unsafe levels. Regular monitoring of kidney function may be necessary, particularly in elderly patients.
- History of psychiatric illness: Patients with a history of depression, anxiety, psychosis, or behavioral disturbance may be at higher risk for psychiatric side effects with levetiracetam. Your doctor will weigh the risks and benefits carefully and may choose more frequent monitoring.
- Suicidal thoughts or self-harm: As with all anti-epileptic drugs, there is a small increased risk of suicidal thoughts and behavior. The FDA and EMA require class-wide warnings about this risk. If you develop new or worsening depression, suicidal thoughts, or unusual changes in mood or behavior, seek medical attention immediately.
- Heart rhythm problems: If you or a family member has a history of irregular heart rhythm (visible on an ECG/EKG), or if you have a condition or take medication that predisposes to heart rhythm disturbances or electrolyte imbalances, inform your doctor before starting levetiracetam.
- Children — growth and puberty: Although uncommon, changes in growth rate or unexpected pubertal development have been reported in children taking levetiracetam. Parents and caregivers should monitor their child's growth and development and report any concerns to the treating physician.
In rare cases, seizures may worsen or occur more frequently after starting levetiracetam or increasing the dose, particularly during the first month. If you notice any worsening of your epilepsy, contact your doctor promptly. Patients with a very rare form of early-onset epilepsy associated with SCN8A mutations may experience continued or worsening seizures during treatment.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, plan to become pregnant, or are breastfeeding, discuss this with your doctor before taking levetiracetam. Levetiracetam should only be used during pregnancy if the treating physician considers it clearly necessary after careful evaluation of the risks and benefits. It is critically important that women with epilepsy do not stop their anti-epileptic medication abruptly during pregnancy, as uncontrolled seizures pose serious risks to both mother and the developing baby, including potential injury, oxygen deprivation, and in severe cases, death.
Current data from pregnancy registries and observational studies are relatively reassuring compared to some other anti-epileptic drugs. Two studies did not suggest an increased risk of autism spectrum disorder or intellectual disability in children born to mothers who took levetiracetam during pregnancy. However, the available evidence on the long-term effects of levetiracetam on the neurodevelopment of exposed children remains limited, and a risk of harm to the unborn child cannot be completely excluded. Women of childbearing potential should be counseled about effective contraception and the importance of planned pregnancies while taking anti-epileptic medication. Folic acid supplementation is generally recommended before and during pregnancy for all women taking anti-epileptic drugs.
Breastfeeding is not recommended during levetiracetam treatment according to the manufacturer's labeling, as levetiracetam passes into breast milk. However, some international guidelines and expert organizations (such as the American Academy of Neurology) consider levetiracetam to be compatible with breastfeeding in many situations, given its low protein binding and the relatively small amount transferred into milk. This decision should be made in consultation with your doctor, weighing the benefits of breastfeeding for the infant against the potential risk of drug exposure.
Driving and Operating Machinery
Levetiracetam may impair your ability to drive or operate machinery because it can cause drowsiness, somnolence (excessive sleepiness), dizziness, and blurred vision. These effects are most likely at the beginning of treatment or after a dose increase. You should not drive, operate heavy machinery, or engage in other potentially hazardous activities until you have established how levetiracetam affects you personally. It is advisable to wait until you have been on a stable dose for several days and are confident that the medication does not impair your alertness or coordination.
How Does Levetiracetam Interact with Other Drugs?
One of the most clinically significant advantages of levetiracetam over many other anti-epileptic drugs is its remarkably low potential for pharmacokinetic drug interactions. This is because levetiracetam has several pharmacological properties that minimize interaction risk: it undergoes minimal hepatic (liver) metabolism (only about 24% of the dose is metabolized, primarily by enzymatic hydrolysis that does not involve cytochrome P450 enzymes), it has very low plasma protein binding (less than 10%), and it does not induce or inhibit the major drug-metabolizing enzymes (CYP1A2, CYP2A6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4). This means levetiracetam is unlikely to alter the blood levels or effectiveness of most other medications, and vice versa.
However, a few interactions and considerations are still important to be aware of:
| Drug | Type | Effect | Recommendation |
|---|---|---|---|
| Macrogol (PEG) | Absorption reduction | Macrogol-based laxatives can reduce the absorption and therefore the effectiveness of levetiracetam | Do not take macrogol within 1 hour before or 1 hour after levetiracetam |
| Methotrexate | Renal competition | Both drugs are renally excreted; co-administration may reduce clearance of either drug | Monitor for increased side effects of both drugs; dose adjustments may be needed |
| Probenecid | Renal competition | May reduce renal tubular secretion of levetiracetam's inactive metabolite, though clinical significance is uncertain | Usually no dose adjustment needed; monitor if used at high doses |
| Other anti-epileptic drugs | Minimal interaction | No clinically significant pharmacokinetic interactions with carbamazepine, phenytoin, valproate, phenobarbital, lamotrigine, gabapentin, or topiramate | No dose adjustments needed for levetiracetam or co-administered anti-epileptic drugs |
| Oral contraceptives | No interaction | Levetiracetam does not reduce the effectiveness of hormonal contraceptives | No additional contraceptive measures needed (unlike many other anti-epileptic drugs) |
| Warfarin | No significant interaction | Levetiracetam does not affect warfarin pharmacokinetics or prothrombin time | No dose adjustments needed |
| Digoxin | No significant interaction | Levetiracetam does not affect digoxin pharmacokinetics | No dose adjustments needed |
The low interaction profile is particularly advantageous for epilepsy patients who often require polytherapy (multiple anti-epileptic drugs) and for patients with comorbid conditions requiring other medications. Unlike enzyme-inducing anti-epileptic drugs such as carbamazepine, phenytoin, and phenobarbital, levetiracetam does not reduce the effectiveness of hormonal contraceptives, immunosuppressants, anticoagulants, or chemotherapy agents. This makes it a practical choice in complex clinical scenarios.
Although there is no specific pharmacokinetic interaction between levetiracetam and alcohol, both substances can cause central nervous system depression (drowsiness, dizziness, impaired coordination). Patients taking levetiracetam should be cautious about alcohol consumption, as the combined sedative effects may be additive.
What Is the Correct Dosage of Levetiracetam?
Levetiracetam should always be taken exactly as prescribed by your doctor or as directed by your pharmacist. The tablets or oral solution are taken twice daily — once in the morning and once in the evening — at approximately the same time each day. Levetiracetam can be taken with or without food. Tablets should be swallowed whole with sufficient liquid (for example, a glass of water). Note that levetiracetam may leave a slightly bitter taste in the mouth.
Adults and Adolescents (from Age 16, Weighing 50 kg or More)
Monotherapy and Adjunctive Therapy
Starting dose: 250 mg twice daily (500 mg/day total), increased after 2 weeks to 500 mg twice daily (1000 mg/day). For adjunctive therapy, some patients may start directly at 500 mg twice daily.
Maintenance dose: 500–1500 mg twice daily (1000–3000 mg/day total).
Dose adjustments: The dose may be increased by 250–500 mg twice daily every 2 weeks, based on clinical response and tolerability, until the optimal dose is reached.
Maximum dose: 1500 mg twice daily (3000 mg/day total).
Adolescents (12–17 Years, Weighing Under 50 kg)
Adjunctive Therapy for Myoclonic and Generalized Tonic-Clonic Seizures
The doctor will prescribe the most appropriate formulation (oral solution or tablets) based on the child's weight. Dosing is calculated per kilogram of body weight.
Starting dose: Typically 10 mg/kg twice daily, increasing to 30 mg/kg twice daily as tolerated.
Children (1 Month to 11 Years)
Adjunctive Therapy for Focal Seizures
Dosing for young children is always weight-based and prescribed by the doctor. The oral solution (100 mg/ml) is the preferred formulation for infants and children under 6 years.
Infants (1–6 months): Starting dose of 7 mg/kg twice daily, increased up to 21 mg/kg twice daily.
Infants and children (6 months to under 4 years): Starting dose of 10 mg/kg twice daily, increased up to 30 mg/kg twice daily.
Children (4 to 11 years, under 50 kg): Starting dose of 10 mg/kg twice daily, increased up to 30 mg/kg twice daily.
Elderly Patients
No specific dose adjustment is required solely due to age. However, because kidney function typically declines with age, dose adjustments based on creatinine clearance are often necessary in elderly patients. Your doctor will assess your kidney function and adjust the dose accordingly. More gradual dose increases may also be considered in elderly patients to improve tolerability.
Kidney Impairment
Because levetiracetam is primarily eliminated through the kidneys, dose reduction is essential in patients with impaired kidney function. Your doctor will determine the appropriate dose based on your creatinine clearance (a measure of kidney function). Patients on dialysis may require supplemental doses after dialysis sessions. Do not adjust the dose yourself; always follow your doctor's specific instructions.
| Kidney Function | Creatinine Clearance | Dose Adjustment |
|---|---|---|
| Normal | > 80 ml/min | Standard dose (500–1500 mg twice daily) |
| Mild impairment | 50–80 ml/min | 500–1000 mg twice daily |
| Moderate impairment | 30–49 ml/min | 250–750 mg twice daily |
| Severe impairment | < 30 ml/min | 250–500 mg twice daily |
| End-stage / Dialysis | — | 500–1000 mg once daily + supplemental dose after dialysis |
Missed Dose
If you forget to take a dose of levetiracetam, take it as soon as you remember, unless it is nearly time for your next scheduled dose. In that case, skip the missed dose and take the next one at the usual time. Do not take a double dose to make up for a missed dose. If you miss multiple doses, contact your doctor for guidance, as a sudden drop in blood levels may increase the risk of seizures.
Overdose
In the event of an overdose, possible symptoms include drowsiness, somnolence, agitation, aggression, decreased level of consciousness, respiratory depression, and coma. If you suspect that you or someone else has taken more levetiracetam than prescribed, contact your doctor or local poison control center immediately, or go to the nearest emergency department. There is no specific antidote for levetiracetam overdose. Treatment is supportive and may include gastric lavage (stomach washout) if performed soon after ingestion. Levetiracetam can be partially removed by hemodialysis.
If your doctor decides to discontinue levetiracetam, the dose should be reduced gradually over at least 2–4 weeks to minimize the risk of rebound seizures. Never stop taking levetiracetam on your own without consulting your doctor first. Levetiracetam is intended as a long-term treatment; continue taking it for as long as your doctor has directed.
What Are the Side Effects of Levetiracetam?
Like all medicines, levetiracetam can cause side effects, although not everybody gets them. The frequency and severity of side effects can vary between patients and may be influenced by the dose, the speed of dose escalation, and individual patient factors. Side effects such as drowsiness, fatigue, and dizziness tend to be most noticeable at the beginning of treatment or after dose increases and often improve as the body adapts to the medication over time.
Contact your doctor immediately or go to the nearest emergency department if you experience any of the following while taking levetiracetam:
- Weakness, dizziness, or difficulty breathing (possible signs of a severe allergic/anaphylactic reaction)
- Swelling of the face, lips, tongue, or throat (angioedema)
- Flu-like symptoms with a rash on the face, followed by a widespread rash with fever, elevated liver enzymes, and swollen lymph nodes (possible DRESS syndrome)
- Small urine volume, tiredness, nausea, vomiting, confusion, and swelling of legs or ankles (possible sudden decline in kidney function)
- Skin rash with blistering resembling targets, particularly around the mouth, nose, eyes, and genitals (erythema multiforme, SJS, or TEN)
- Signs of serious mental changes: confusion, drowsiness, amnesia, abnormal behavior, or involuntary/uncontrollable movements (possible encephalopathy)
Very Common
May affect more than 1 in 10 people
- Nasopharyngitis (inflammation of the nose and throat — cold-like symptoms)
- Somnolence (drowsiness, excessive sleepiness)
- Headache
Common
May affect up to 1 in 10 people
- Loss of appetite (anorexia)
- Depression, hostility or aggression, anxiety, insomnia, nervousness, or irritability
- Convulsions, balance disturbances, dizziness, lethargy, tremor
- Vertigo (spinning sensation)
- Cough
- Abdominal pain, diarrhea, dyspepsia (indigestion), nausea, vomiting
- Skin rash
- Asthenia/fatigue (weakness, tiredness)
Uncommon
May affect up to 1 in 100 people
- Decreased platelet count (thrombocytopenia), decreased white blood cell count (leukopenia)
- Weight loss or weight gain
- Suicidal thoughts or attempted suicide, mental disturbance, abnormal behavior, hallucinations, anger, confusion, panic attack, emotional instability/mood swings, agitation
- Memory loss (amnesia), impaired memory, impaired coordination (ataxia), tingling or numbness (paresthesia), difficulty concentrating
- Double vision (diplopia), blurred vision
- Elevated/abnormal liver function tests
- Hair loss (alopecia), eczema, itching (pruritus)
- Muscle weakness, muscle pain (myalgia)
- Accidental injury
Rare
May affect up to 1 in 1,000 people
- Infection
- Decreased counts of all blood cell types (pancytopenia)
- Severe allergic reactions (DRESS, anaphylaxis, angioedema)
- Low sodium levels in the blood (hyponatremia)
- Suicidal behavior, personality disorder, abnormal thinking
- Delirium, encephalopathy
- Worsening or more frequent seizures
- Uncontrollable muscle spasms (dyskinesia), hyperactivity (hyperkinesia)
- Changes in heart rhythm (ECG changes)
- Pancreatitis, liver failure, hepatitis
- Acute kidney injury
- Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis
- Rhabdomyolysis (muscle breakdown) — risk is significantly higher in Japanese patients
- Gait disturbance or difficulty walking
- Neuroleptic malignant syndrome (fever, muscle rigidity, unstable vital signs, confusion) — risk is significantly higher in Japanese patients
Very Rare
May affect up to 1 in 10,000 people
- Obsessive-compulsive disorder (OCD) — recurring intrusive thoughts or compulsive repetitive behaviors
Psychiatric and Behavioral Side Effects
The psychiatric and behavioral side effects of levetiracetam deserve particular attention because they are among the most common reasons for treatment discontinuation and can significantly affect quality of life. In clinical trials, behavioral adverse events (broadly defined as irritability, aggression, hostility, anxiety, and personality change) were reported in approximately 10–15% of patients taking levetiracetam, compared with about 6% taking placebo. These effects appear to be dose-related and are more common in patients with a prior history of psychiatric illness.
Most behavioral side effects are mild to moderate and reversible upon dose reduction or discontinuation. However, in a small minority of patients, they can be severe enough to require treatment discontinuation. If you or those around you notice significant changes in mood, behavior, or personality, it is important to discuss this with your doctor. Dose reduction rather than abrupt discontinuation may be an appropriate first step, as stopping levetiracetam suddenly carries the risk of rebound seizures.
Many common side effects of levetiracetam (drowsiness, headache, mild dizziness) are benign and tend to improve over time. However, you should contact your doctor promptly if you experience any rash, skin blistering, severe mood or behavioral changes, signs of allergic reaction, or any symptom that concerns you. Reporting side effects helps improve drug safety monitoring for all patients.
How Should You Store Levetiracetam?
Keep levetiracetam tablets and oral solution out of the sight and reach of children at all times. Store the medication in its original packaging. No special temperature or humidity requirements apply to the film-coated tablets — standard room temperature storage is appropriate. For the oral solution, follow any specific storage instructions provided on the packaging (such as refrigeration after opening, if applicable).
Do not use levetiracetam after the expiration date (EXP) printed on the blister pack, carton, or bottle. The expiration date refers to the last day of the indicated month. Medicines should not be disposed of via wastewater or household waste. Return any unused or expired medication to a pharmacy for safe disposal. These measures help to protect the environment and prevent accidental exposure.
What Does Levetiracetam Contain?
Film-Coated Tablets
Each film-coated tablet contains 250 mg, 500 mg, 750 mg, or 1000 mg of levetiracetam as the active substance. The tablet cores contain croscarmellose sodium, macrogol 6000, colloidal anhydrous silica, and magnesium stearate. The film coating contains partially hydrolyzed polyvinyl alcohol, titanium dioxide (E171), macrogol 3350, talc, and color-specific pigments.
The tablets are color-coded by strength for easy identification:
- 250 mg: Blue, oblong (13 mm), scored, engraved “ucb” and “250” — colorant: indigo carmine (E132)
- 500 mg: Yellow, oblong (16 mm), scored, engraved “ucb” and “500” — colorant: yellow iron oxide (E172)
- 750 mg: Orange, oblong (18 mm), scored, engraved “ucb” and “750” — colorants: sunset yellow FCF aluminum lake (E110) and red iron oxide (E172). Note: Sunset yellow (E110) may cause allergic reactions in some individuals.
- 1000 mg: White, oblong (19 mm), scored, engraved “ucb” and “1000”
The score line on all tablets is intended solely to facilitate swallowing, not for dividing the tablet into equal doses. All tablet strengths contain less than 1 mmol (23 mg) of sodium per tablet, meaning they are essentially sodium-free.
Oral Solution
The oral solution contains 100 mg of levetiracetam per ml. It is particularly suitable for infants, young children under 6 years of age, and older children or adolescents weighing less than 50 kg for whom the dosage recommendation cannot be achieved with available tablet strengths. The solution allows precise, weight-based dosing using the provided measuring syringe or cup.
Solution for Infusion
The intravenous formulation contains 5 mg of levetiracetam per ml (available as 500 mg/100 ml). It is used in clinical settings when oral administration is temporarily not possible. The intravenous dose is identical to the established oral dose, as the oral bioavailability of levetiracetam approaches 100%.
Frequently Asked Questions About Levetiracetam
Levetiracetam is used to treat epilepsy (seizure disorders). It can be used as the sole treatment (monotherapy) for focal (partial) seizures with or without secondary generalization in adults and adolescents from 16 years of age. It is also used as add-on therapy for focal seizures (from 1 month of age), myoclonic seizures in juvenile myoclonic epilepsy (from 12 years), and primary generalized tonic-clonic seizures in idiopathic generalized epilepsy (from 12 years). It is one of the most widely prescribed anti-epileptic drugs worldwide and is listed on the WHO Model List of Essential Medicines.
Yes, behavioral and psychiatric side effects are among the most clinically important adverse effects of levetiracetam. Approximately 10–15% of patients may experience irritability, aggression, hostility, anxiety, depression, mood swings, or personality changes. These effects tend to be more common during the first weeks of treatment or after dose increases, and in patients with a pre-existing history of psychiatric illness. In uncommon cases, more severe effects such as suicidal thoughts, hallucinations, or psychotic symptoms can occur. If you or those close to you notice significant mood or behavioral changes, contact your doctor promptly. Most behavioral side effects are reversible with dose reduction or discontinuation.
No. You should never stop taking levetiracetam abruptly without medical supervision. Sudden discontinuation can cause seizures to return or worsen, including potentially dangerous rebound seizures. If treatment needs to be stopped, your doctor will instruct you to reduce the dose gradually over at least 2–4 weeks. Even if you experience side effects that concern you, do not stop the medication on your own; instead, contact your doctor to discuss the best course of action.
Levetiracetam should only be used during pregnancy if the doctor considers it clearly necessary after careful evaluation. Current data from pregnancy registries are relatively reassuring: two studies did not indicate an increased risk of autism or intellectual disability in children exposed in utero. However, long-term neurodevelopmental data remain limited, and a risk of birth defects cannot be entirely excluded. Critically, women with epilepsy should never stop their anti-epileptic medication abruptly during pregnancy, as uncontrolled seizures are dangerous for both mother and baby. Folic acid supplementation is generally recommended. Discuss pregnancy planning with your neurologist well in advance.
No — this is one of levetiracetam's most significant clinical advantages. It has an unusually low potential for drug interactions because it undergoes minimal liver metabolism, has very low protein binding (less than 10%), and does not induce or inhibit cytochrome P450 enzymes. This means it rarely affects the blood levels of other medications and other medications rarely affect its levels. The most notable interaction is with macrogol (polyethylene glycol) laxatives, which should not be taken within one hour before or after levetiracetam. Unlike many other anti-epileptic drugs, levetiracetam does not reduce the effectiveness of hormonal contraceptives.
Levetiracetam stands out from other anti-epileptic drugs in several important ways. Its mechanism of action is unique — it binds to SV2A protein on synaptic vesicles rather than targeting sodium channels, calcium channels, or GABA receptors. It has near-complete oral bioavailability (close to 100%), meaning oral and intravenous doses are directly interchangeable. It undergoes minimal liver metabolism and has very low protein binding, giving it an exceptionally low drug interaction profile. The dose can be increased relatively quickly (every 2 weeks) compared to medications like lamotrigine, which require very slow titration. It is also available in three formulations (tablets, oral solution, and intravenous), making it highly versatile for different clinical situations.
References
- World Health Organization (WHO). WHO Model List of Essential Medicines — 23rd List, 2023. Geneva: WHO; 2023. Levetiracetam is listed as an essential anti-epileptic medicine.
- European Medicines Agency (EMA). Keppra (Levetiracetam) — Summary of Product Characteristics (SmPC). European public assessment report. Last updated 2025.
- U.S. Food and Drug Administration (FDA). Keppra (Levetiracetam) — Full Prescribing Information. Revised 2024.
- National Institute for Health and Care Excellence (NICE). Epilepsies in Children, Young People and Adults (NG217). NICE Guideline, updated 2024.
- British National Formulary (BNF). Levetiracetam. NICE Evidence Services. Accessed December 2025.
- Brodie MJ, Perucca E, Ryvlin P, Ben-Menachem E, Meencke HJ; Levetiracetam Monotherapy Study Group. Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. Neurology. 2007;68(6):402-408. doi:10.1212/01.wnl.0000252941.50833.4a
- Lynch BA, Lambeng N, Bhatt DK, et al. The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci USA. 2004;101(26):9861-9866. doi:10.1073/pnas.0308208101
- Tomson T, Battino D, Bonizzoni E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurol. 2018;17(6):530-538. doi:10.1016/S1474-4422(18)30107-8
- Mbizvo GK, Dixon P, Hutton JL, Marson AG. Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review. Cochrane Database Syst Rev. 2012;(9):CD001901. doi:10.1002/14651858.CD001901.pub2
- Mula M, Trimble MR, Sander JW. Psychiatric adverse events in patients with epilepsy and learning disabilities taking levetiracetam. Seizure. 2004;13(1):55-57. doi:10.1016/S1059-1311(03)00099-X
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in neurology, epileptology, and clinical pharmacology. All content is based on current international guidelines (WHO, EMA, FDA, NICE, BNF) and peer-reviewed research. The team follows the GRADE evidence framework and has no conflicts of interest or commercial funding.
iMedic Medical Editorial Team — Specialists in neurology, epileptology, and clinical pharmacology with expertise in anti-epileptic medications and seizure disorders.
iMedic Medical Review Board — Independent panel of medical experts who review all content according to international guidelines and the GRADE evidence framework.
Evidence Level: 1A — Based on systematic reviews, meta-analyses of randomized controlled trials, and international clinical guidelines. Last reviewed: .