Levetiracetam ratiopharm: Uses, Dosage & Side Effects
An antiepileptic drug (AED) that binds to synaptic vesicle protein SV2A to control seizures in epilepsy, available as 250 mg film-coated tablets
Levetiracetam ratiopharm contains the active substance levetiracetam, a widely prescribed antiepileptic drug (AED) used to control seizures in people with epilepsy. It works through a unique mechanism of action by binding to synaptic vesicle protein 2A (SV2A) in the brain, modulating neurotransmitter release to reduce excessive neuronal activity. Levetiracetam is approved for the treatment of partial onset seizures (focal seizures), myoclonic seizures in juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures. Listed on the WHO Model List of Essential Medicines, it is one of the most frequently prescribed antiepileptic drugs worldwide due to its broad efficacy, favorable pharmacokinetic profile, minimal drug interactions, and well-established safety record in both adults and children.
Quick Facts: Levetiracetam ratiopharm
Key Takeaways
- Levetiracetam ratiopharm is a generic antiepileptic drug containing levetiracetam, used to treat focal (partial) seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in both adults and children.
- It works through a unique mechanism by binding to synaptic vesicle protein 2A (SV2A), which modulates neurotransmitter release without acting on traditional ion channels or GABA receptors.
- Levetiracetam has minimal drug interactions because it is not significantly metabolized by the cytochrome P450 enzyme system, making it particularly useful in patients taking multiple medications.
- Common side effects include drowsiness, headache, and fatigue; psychiatric and behavioral effects such as irritability and mood changes should be monitored, especially in children and adolescents.
- Treatment must never be stopped abruptly — doses should be gradually reduced over at least 2–4 weeks under medical supervision to prevent rebound seizures.
What Is Levetiracetam ratiopharm and What Is It Used For?
Levetiracetam ratiopharm contains the active substance levetiracetam, which belongs to a class of medications known as antiepileptic drugs (AEDs) or anticonvulsants. Levetiracetam is the S-enantiomer of alpha-ethyl-2-oxo-1-pyrrolidine acetamide and has a unique chemical structure that distinguishes it from all other currently available antiepileptic agents. Unlike traditional anticonvulsants that primarily act on sodium channels, calcium channels, or GABA-mediated neurotransmission, levetiracetam exerts its therapeutic effects through a novel mechanism involving the synaptic vesicle protein 2A (SV2A).
SV2A is a transmembrane glycoprotein found in the membranes of synaptic vesicles throughout the central nervous system. These vesicles are the small cellular compartments that store neurotransmitters and release them into the synaptic cleft during normal neuronal communication. By binding to SV2A with high affinity, levetiracetam modulates the process of synaptic vesicle exocytosis — the mechanism by which neurotransmitters are released from nerve endings. Research has demonstrated that levetiracetam preferentially inhibits excessive neuronal firing, such as that which occurs during epileptic seizures, while having relatively less impact on normal physiological neurotransmission. This selectivity is thought to underlie the drug's favorable tolerability profile compared to many older antiepileptic agents.
The clinical development of levetiracetam began in the late 1990s, and the original branded formulation (Keppra) was first approved by the European Medicines Agency (EMA) in 2000 and by the U.S. Food and Drug Administration (FDA) in 1999. Since the expiration of the original patent, numerous generic formulations — including Levetiracetam ratiopharm — have become available worldwide. These generic versions contain the same active substance in bioequivalent formulations and are approved through rigorous regulatory pathways that ensure comparable efficacy and safety to the original product.
Levetiracetam is included on the World Health Organization (WHO) Model List of Essential Medicines, reflecting its importance as a fundamental treatment for epilepsy in global healthcare systems. It is currently one of the most widely prescribed antiepileptic drugs in the world, used in both developed and developing countries across a wide range of patient populations.
Approved Indications
Levetiracetam ratiopharm is approved for the following clinical indications:
- Monotherapy for focal (partial onset) seizures: In adults and adolescents from 16 years of age with newly diagnosed epilepsy, levetiracetam can be used as the sole antiepileptic drug. Focal seizures originate in a specific area of the brain and may or may not spread to become bilateral tonic-clonic (formerly called secondarily generalized) seizures. Clinical trials have demonstrated that levetiracetam monotherapy is non-inferior to controlled-release carbamazepine for seizure freedom in this population.
- Adjunctive therapy for focal (partial onset) seizures: In adults, adolescents, children, and infants from 1 month of age, levetiracetam can be added to existing antiepileptic treatment for focal seizures with or without secondary generalization. Multiple randomized controlled trials have shown that adding levetiracetam significantly reduces seizure frequency compared with placebo in patients whose seizures are not adequately controlled with other medications.
- Adjunctive therapy for myoclonic seizures: In adults and adolescents from 12 years of age with juvenile myoclonic epilepsy (JME), levetiracetam can be used as add-on therapy. JME is a common generalized epilepsy syndrome characterized by myoclonic jerks, often occurring shortly after waking. Levetiracetam has been shown to significantly reduce the frequency of myoclonic seizure days in this population.
- Adjunctive therapy for primary generalized tonic-clonic seizures: In adults and adolescents from 12 years of age with idiopathic generalized epilepsy, levetiracetam is approved as add-on treatment for primary generalized tonic-clonic (PGTC) seizures. These are seizures that originate simultaneously in both brain hemispheres and involve loss of consciousness with bilateral convulsions. Clinical trials demonstrated that levetiracetam significantly reduced PGTC seizure frequency compared with placebo.
The World Health Organization includes levetiracetam on its Model List of Essential Medicines, which identifies the most important medications needed in a basic health system. This designation reflects the drug's proven efficacy, established safety profile, favorable pharmacokinetic properties, and importance in the global management of epilepsy. Levetiracetam is considered a first-line treatment option for several seizure types by major epilepsy guidelines including ILAE and NICE.
What Should You Know Before Taking Levetiracetam ratiopharm?
Contraindications
The primary contraindication to Levetiracetam ratiopharm is hypersensitivity (allergy) to levetiracetam, to other pyrrolidone derivatives (such as piracetam), or to any of the other ingredients contained in the film-coated tablet formulation. If you have previously experienced an allergic reaction to levetiracetam or any related substance, you must not use this medication.
Although serious allergic reactions to levetiracetam are uncommon, they have been reported in post-marketing surveillance. These include anaphylaxis, angioedema, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). While these reactions are very rare, they can be life-threatening and require immediate medical attention. If you develop a skin rash, blistering, or swelling of the face, lips, tongue, or throat while taking levetiracetam, stop the medication and seek emergency medical care immediately.
Warnings and Precautions
Never stop taking levetiracetam suddenly without consulting your doctor. Abrupt discontinuation of antiepileptic drugs can lead to rebound seizures, which may be more frequent or severe than usual and can be life-threatening. If treatment needs to be discontinued, your doctor will reduce the dose gradually over at least 2–4 weeks.
Levetiracetam may cause psychiatric and behavioral adverse effects including irritability, aggression, agitation, anger, anxiety, depressed mood, emotional lability, hostility, and in rare cases psychotic symptoms, suicidal ideation, and suicide attempt. These effects are more commonly reported in children and adolescents. Patients, family members, and caregivers should be alert to changes in mood or behavior and report them to a healthcare provider promptly.
Before starting Levetiracetam ratiopharm, discuss the following with your healthcare provider:
- Kidney disease: Levetiracetam is primarily eliminated by the kidneys. Patients with impaired renal function may require dose adjustments based on creatinine clearance. If you have any degree of kidney disease, your doctor will need to calculate the appropriate dose for you. Regular monitoring of renal function may be recommended during treatment.
- Liver disease: While levetiracetam is not significantly metabolized by the liver, patients with severe hepatic impairment may also have reduced renal function. Liver function should be assessed before and periodically during treatment, particularly in patients with pre-existing liver disease.
- Depression and suicidal ideation: Antiepileptic drugs, including levetiracetam, have been associated with a small increased risk of suicidal thoughts and behavior. A meta-analysis conducted by regulatory authorities found approximately double the risk of suicidality (0.43% vs 0.24%) in patients treated with antiepileptic drugs compared with placebo. Patients with a history of depression, anxiety, or suicidal behavior should be closely monitored during treatment.
- Hematological effects: Rare cases of decreased blood cell counts (leukopenia, neutropenia, pancytopenia, thrombocytopenia, and agranulocytosis) have been reported with levetiracetam use. Although routine blood monitoring is not typically required, a complete blood count should be performed if symptoms suggestive of hematological abnormalities develop, such as unexplained fever, sore throat, bruising, or bleeding.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to become pregnant, you should consult your neurologist or epilepsy specialist before making any changes to your medication. Uncontrolled seizures during pregnancy pose serious risks to both the mother and the developing baby, including injury from falls, oxygen deprivation, and an increased risk of sudden unexpected death in epilepsy (SUDEP). Therefore, antiepileptic treatment should not be stopped during pregnancy without careful medical consideration.
Data from epilepsy pregnancy registries (including the UK Epilepsy and Pregnancy Register, the North American AED Pregnancy Registry, and the EURAP registry) suggest that levetiracetam monotherapy is associated with a relatively lower rate of major congenital malformations compared with some other antiepileptic drugs, particularly valproate. The overall rate of major congenital malformations with levetiracetam monotherapy has been reported to be in the range of 2–3%, which is close to the background rate in the general population (2–3%). However, no antiepileptic drug can be considered completely safe during pregnancy, and the decision to use levetiracetam must be individualized.
Folic acid supplementation (typically 5 mg daily) is recommended for all women of childbearing potential taking antiepileptic drugs, ideally starting before conception and continuing throughout the first trimester, to reduce the risk of neural tube defects. Women of childbearing potential should discuss family planning and contraception with their neurologist or epilepsy specialist.
Levetiracetam is excreted in human breast milk. The concentration in breast milk is approximately 100% of the maternal plasma concentration, resulting in estimated infant exposure of approximately 4–8% of the maternal dose per kilogram. While clinical effects on breastfed infants have not been commonly reported, drowsiness and feeding difficulties have been observed in rare cases. The decision to breastfeed during levetiracetam treatment should be made in consultation with your doctor, weighing the established benefits of breastfeeding against the potential risk to the infant.
Children and Adolescents
Levetiracetam is approved for use in pediatric patients, with the specific indication depending on the patient's age. As adjunctive therapy for focal seizures, it is approved from 1 month of age. For adjunctive therapy of myoclonic seizures and primary generalized tonic-clonic seizures, it is approved from 12 years of age. The dose in children is calculated based on body weight (mg/kg). Behavioral and psychiatric side effects, particularly irritability and aggression, may be more prominent in children and adolescents compared with adults, and parents and caregivers should be informed about these potential effects.
Driving and Operating Machinery
Levetiracetam may cause somnolence (drowsiness), dizziness, and other nervous system effects that could impair your ability to drive or operate machinery. These effects are most pronounced during the initial weeks of treatment and during dose adjustments. You should not drive or use machines until you have determined how levetiracetam affects you. Additionally, epilepsy itself may impose legal restrictions on driving in many countries. Consult your doctor and local regulations regarding driving with epilepsy.
How Does Levetiracetam ratiopharm Interact with Other Drugs?
One of the most significant clinical advantages of levetiracetam compared with many older antiepileptic drugs (such as carbamazepine, phenytoin, phenobarbital, and valproate) is its remarkably clean drug interaction profile. Levetiracetam is not significantly metabolized by the hepatic cytochrome P450 (CYP) enzyme system, the primary pathway through which most drug interactions occur. Instead, the major metabolic pathway of levetiracetam involves enzymatic hydrolysis of the acetamide group by type B esterases in the blood, producing the inactive metabolite ucb L057. This metabolic route is independent of CYP enzymes, which means levetiracetam neither inhibits nor induces CYP-mediated drug metabolism.
Approximately 66% of a levetiracetam dose is excreted unchanged in the urine through glomerular filtration and partial tubular reabsorption. The remaining 34% is metabolized to inactive metabolites. Because of this predominantly renal elimination and non-CYP metabolism, levetiracetam has minimal potential for pharmacokinetic interactions with other medications. This is a particularly valuable property in epilepsy treatment, where patients frequently need to take multiple drugs simultaneously.
Despite its favorable overall profile, some drug interactions with levetiracetam have been identified or are theoretically possible:
| Drug / Category | Type of Interaction | Clinical Significance |
|---|---|---|
| Methotrexate | Levetiracetam may reduce renal clearance of methotrexate | Clinically significant — monitor methotrexate levels |
| Carbamazepine, Phenytoin, Phenobarbital | Enzyme inducers may slightly decrease levetiracetam plasma levels (10–20%) | Usually not clinically significant; dose adjustment rarely needed |
| Valproate | No significant pharmacokinetic interaction | Can be safely combined |
| Oral contraceptives | No effect on ethinylestradiol or levonorgestrel levels | Safe to use — contraceptive efficacy maintained |
| Digoxin | No pharmacokinetic interaction identified | Can be safely combined |
| Warfarin | No effect on prothrombin time or INR | Can be safely combined |
| Probenecid | May increase levels of the primary metabolite (ucb L057) but not levetiracetam itself | Low clinical significance; metabolite is inactive |
| CNS depressants (alcohol, benzodiazepines) | Pharmacodynamic: additive sedative effects | Avoid excessive alcohol; use caution with sedatives |
Important Pharmacokinetic Considerations
Unlike carbamazepine, phenytoin, and phenobarbital, levetiracetam does not induce hepatic enzymes. This means it does not accelerate the metabolism of other drugs, including oral contraceptives, immunosuppressants, anticoagulants, or chemotherapy agents. This property makes levetiracetam an especially valuable option for patients with epilepsy who need to take medications for other conditions, such as women requiring reliable hormonal contraception, patients with cancer, organ transplant recipients, or individuals on anticoagulation therapy.
Similarly, levetiracetam does not inhibit CYP enzymes, so it does not increase the plasma levels of other drugs to potentially toxic concentrations. This bidirectional absence of clinically significant CYP interactions is a key factor in the drug's widespread use as both monotherapy and adjunctive therapy in epilepsy management.
Unlike many older antiepileptic drugs (carbamazepine, phenytoin, phenobarbital, topiramate at high doses), levetiracetam does not reduce the effectiveness of hormonal contraceptives. This makes it a preferred choice for women of childbearing potential who rely on oral contraceptive pills, patches, or rings for birth control. A dedicated pharmacokinetic study confirmed that levetiracetam (500 mg twice daily) had no effect on the plasma levels of ethinylestradiol or levonorgestrel.
What Is the Correct Dosage of Levetiracetam ratiopharm?
The dosage of Levetiracetam ratiopharm must be individualized based on the patient's age, weight, kidney function, seizure type, and clinical response. The tablets should be swallowed whole with sufficient liquid and can be taken with or without food. Levetiracetam is administered in two equal doses per day (morning and evening), ideally at approximately the same times each day to maintain stable blood levels.
Adults and Adolescents (from 50 kg Body Weight)
Monotherapy (Focal Seizures)
The recommended starting dose is 250 mg twice daily (500 mg/day), which may be increased after 2 weeks to the initial therapeutic dose of 500 mg twice daily (1,000 mg/day). Depending on the clinical response, the dose may be further increased in increments of 250 mg twice daily every 2 weeks, up to a maximum of 1,500 mg twice daily (3,000 mg/day).
Adjunctive Therapy (Focal, Myoclonic, and PGTC Seizures)
The recommended starting dose is 500 mg twice daily (1,000 mg/day). The dose may be increased in increments of 500 mg twice daily every 2–4 weeks, up to a maximum of 1,500 mg twice daily (3,000 mg/day). Some patients may respond to lower doses, and your doctor will prescribe the lowest effective dose for seizure control.
Children
| Age Group | Starting Dose | Maximum Dose | Notes |
|---|---|---|---|
| Infants 1–6 months | 7 mg/kg twice daily | 21 mg/kg twice daily | Adjunctive therapy for focal seizures; oral solution preferred |
| Infants/children 6 months–4 years | 10 mg/kg twice daily | 30 mg/kg twice daily | Adjunctive therapy for focal seizures; oral solution preferred |
| Children 4–11 years | 10 mg/kg twice daily | 30 mg/kg twice daily | Adjunctive therapy for focal seizures |
| Adolescents 12–17 years (<50 kg) | 10 mg/kg twice daily | 30 mg/kg twice daily | Focal, myoclonic, and PGTC seizures |
| Adolescents 12–17 years (≥50 kg) | 500 mg twice daily | 1,500 mg twice daily | Same as adult dosing |
Elderly Patients
No specific dose adjustment is generally required in elderly patients solely based on age. However, since kidney function tends to decline with age, the dose of levetiracetam should be adjusted based on the patient's creatinine clearance. Your doctor will calculate the appropriate dose using blood tests to assess kidney function. Elderly patients may also be more susceptible to the sedative effects of levetiracetam, so a slower dose titration may be advisable.
Patients with Kidney Impairment
| Renal Function (CrCl) | Dose Range | Dosing Interval |
|---|---|---|
| Normal (>80 mL/min) | 500–1,500 mg twice daily | Every 12 hours |
| Mild (50–80 mL/min) | 500–1,000 mg twice daily | Every 12 hours |
| Moderate (30–49 mL/min) | 250–750 mg twice daily | Every 12 hours |
| Severe (<30 mL/min) | 250–500 mg twice daily | Every 12 hours |
| End-stage renal disease (on dialysis) | 500–1,000 mg once daily + supplemental dose after dialysis | Every 24 hours + post-dialysis supplement |
Missed Dose
If you forget to take a dose of Levetiracetam ratiopharm, take it as soon as you remember. However, if it is almost time for your next scheduled dose (within a few hours), skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed dose. Maintaining a consistent dosing schedule is important for optimal seizure control. Setting a daily alarm or using a medication reminder app can help you remember to take your medication on time.
Overdose
If you suspect you have taken more levetiracetam than prescribed, contact your doctor or poison control center immediately, or go to the nearest emergency department. Symptoms of levetiracetam overdose may include drowsiness, agitation, aggression, decreased consciousness, respiratory depression, and coma. There is no specific antidote for levetiracetam overdose. Treatment is supportive and may include gastric lavage (stomach pumping) if performed shortly after ingestion. Levetiracetam is dialyzable (approximately 50% of the drug can be removed by standard 4-hour hemodialysis), and hemodialysis may be considered in cases of severe overdose, particularly in patients with kidney impairment.
What Are the Side Effects of Levetiracetam ratiopharm?
Like all medicines, Levetiracetam ratiopharm can cause side effects, although not everybody gets them. The safety profile of levetiracetam has been extensively studied in clinical trials involving thousands of patients and through decades of post-marketing surveillance. Most side effects are dose-related and tend to be most noticeable during the initial weeks of treatment and during dose escalation. Many side effects improve or resolve over time as the body adjusts to the medication.
The following classification uses the standard frequency categories defined by the Council for International Organizations of Medical Sciences (CIOMS):
Very Common
Affects more than 1 in 10 people
- Somnolence (drowsiness, sleepiness)
- Headache
- Nasopharyngitis (common cold symptoms)
Common
Affects 1 in 10 to 1 in 100 people
- Fatigue (tiredness)
- Dizziness
- Irritability
- Aggression
- Insomnia (difficulty sleeping)
- Depression
- Anxiety
- Nervousness
- Convulsion (paradoxical seizure worsening in rare cases)
- Vertigo (sensation of spinning)
- Tremor
- Loss of appetite (anorexia)
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Cough
- Rash
- Diplopia (double vision)
- Blurred vision
Uncommon
Affects 1 in 100 to 1 in 1,000 people
- Leukopenia (low white blood cell count)
- Thrombocytopenia (low platelet count)
- Weight gain
- Weight loss
- Suicidal ideation
- Psychotic disorder
- Personality disorder (behavioral disturbance)
- Abnormal thinking
- Hallucination
- Memory impairment
- Coordination difficulties (ataxia)
- Paresthesia (tingling or numbness)
- Myalgia (muscle pain)
- Alopecia (hair loss)
- Eczema
- Elevated liver enzymes
Rare
Affects 1 in 1,000 to 1 in 10,000 people
- Pancytopenia (reduction in all blood cell types)
- Agranulocytosis (severely low white blood cells)
- Suicide attempt
- Completed suicide
- Pancreatitis (inflammation of the pancreas)
- Hepatic failure (liver failure)
- Hepatitis (liver inflammation)
- Stevens-Johnson syndrome (severe skin reaction)
- Toxic epidermal necrolysis (severe skin reaction)
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- Hyponatremia (low sodium levels)
- Rhabdomyolysis (muscle breakdown)
Psychiatric and Behavioral Side Effects
Among the most clinically important side effects of levetiracetam are psychiatric and behavioral adverse reactions. These include irritability, aggression, agitation, anger, anxiety, apathy, depression, emotional lability (mood swings), and hostility. In clinical trials, behavioral adverse events were reported in approximately 13% of levetiracetam-treated patients compared with 6% of placebo-treated patients. These effects are more frequently observed in children and adolescents, where rates of behavioral adverse events have been reported in up to 20–38% of pediatric patients in some studies.
While most psychiatric side effects are mild to moderate and manageable, severe reactions including psychotic symptoms, suicidal ideation, and suicide attempts have been reported. The U.S. FDA requires a class-wide warning for all antiepileptic drugs regarding the risk of suicidal behavior and ideation. Patients, family members, and caregivers should be educated about the potential for these effects and should report any concerning changes in mood, behavior, or thinking to their healthcare provider promptly.
Strategies for managing behavioral side effects of levetiracetam include gradual dose titration, dose reduction, and in some cases, the addition of a low-dose vitamin B6 (pyridoxine) supplement, which has been reported in several studies to ameliorate levetiracetam-induced irritability, although the evidence for this approach is limited. If severe psychiatric symptoms develop, discontinuation of levetiracetam (with gradual dose tapering) and transition to an alternative antiepileptic drug may be necessary.
Seek emergency medical care if you experience: severe allergic reactions (swelling of the face, lips, tongue, or throat; difficulty breathing; severe skin rash or blistering); thoughts of self-harm or suicide; signs of severe infection (high fever, severe sore throat, mouth ulcers); unusual bruising or bleeding; signs of liver problems (persistent nausea, yellowing of the skin or eyes, dark urine); or signs of severe skin reactions (widespread rash with blistering and peeling).
How Should You Store Levetiracetam ratiopharm?
Proper storage of medications is essential to maintain their efficacy and safety. Levetiracetam ratiopharm film-coated tablets should be stored at room temperature, not exceeding 25°C (77°F). The tablets should be kept in their original packaging (blister pack or bottle) to protect them from moisture and light exposure, which could potentially affect the stability of the medication.
Keep the tablets out of the sight and reach of children. It is recommended to store medications in a secure location, such as a locked cabinet, particularly since levetiracetam is a prescription medication that could be harmful if taken inappropriately by children or others for whom it is not prescribed.
Do not use Levetiracetam ratiopharm after the expiry date printed on the blister packaging and outer carton. The expiry date refers to the last day of that month. If you notice any visible changes in the appearance of the tablets (such as discoloration, crumbling, or unusual odor), do not take them and consult your pharmacist.
Do not dispose of unused medications by flushing them down the toilet or throwing them in household waste, as this can contaminate the environment. Return any unused or expired tablets to your pharmacy for safe disposal in accordance with local regulations. Many pharmacies and municipalities offer medication take-back programs for safe and environmentally responsible disposal.
What Does Levetiracetam ratiopharm Contain?
Understanding the composition of your medication is important, particularly if you have known allergies or intolerances to specific substances. Each Levetiracetam ratiopharm 250 mg film-coated tablet contains the following:
Active Ingredient
Each film-coated tablet contains 250 mg of levetiracetam as the active substance. Levetiracetam is the S-enantiomer of alpha-ethyl-2-oxo-1-pyrrolidine acetamide, with a molecular formula of C8H14N2O2 and a molecular weight of 170.21 g/mol. It is a white to off-white crystalline powder that is freely soluble in water.
Excipients (Inactive Ingredients)
The inactive ingredients in the tablet core typically include:
- Microcrystalline cellulose — a plant-derived filler and binder
- Croscarmellose sodium — a disintegrant that helps the tablet break apart in the stomach
- Colloidal anhydrous silica — a flow agent used in the manufacturing process
- Magnesium stearate — a lubricant used during tablet compression
The film coating typically contains:
- Polyvinyl alcohol — a film-forming polymer
- Titanium dioxide (E171) — a white colorant and opacifier
- Macrogol (polyethylene glycol) — a plasticizer for the film coat
- Talc — an anti-adherent used in the coating process
- Iron oxide yellow (E172) — a colorant (for the 250 mg tablet strength)
Levetiracetam ratiopharm tablets do not contain lactose, sucrose, or gluten. The 250 mg tablets are typically blue, oval-shaped, biconvex, film-coated tablets with a score line on one side to facilitate dose splitting if needed. However, the exact appearance may vary between manufacturers and production batches. Always verify the appearance description on your specific product packaging.
Levetiracetam tablets are available in various strengths (250 mg, 500 mg, 750 mg, and 1,000 mg), typically differentiated by color and size. This Levetiracetam ratiopharm product is available as 250 mg film-coated tablets. If you are unsure about the identity of your tablets, contact your pharmacist for verification. An oral solution formulation is also available for patients who have difficulty swallowing tablets, particularly young children.
Frequently Asked Questions About Levetiracetam ratiopharm
Levetiracetam ratiopharm is a generic version of the original branded product Keppra. Both contain the same active substance (levetiracetam) in the same dose and are considered bioequivalent, meaning they are absorbed into the body at the same rate and to the same extent. Generic medications must meet strict regulatory requirements demonstrating bioequivalence to the original product before they can be approved and marketed. The primary difference is typically the manufacturer and the price, with generic versions generally being more affordable.
It is generally advisable to limit or avoid alcohol while taking levetiracetam. Alcohol can worsen the drowsiness and dizziness that levetiracetam may cause (a pharmacodynamic interaction). Additionally, alcohol can lower the seizure threshold, potentially making seizures more likely. While moderate, occasional alcohol consumption may not be strictly prohibited, you should discuss your alcohol use with your doctor and be aware that even small amounts may have a greater effect than you are accustomed to while on this medication.
The duration of levetiracetam treatment depends on your individual circumstances and the type of epilepsy you have. Many people with epilepsy need to take antiepileptic medication for several years, and some may need lifelong treatment. After a seizure-free period of at least 2–5 years, your neurologist may consider gradually reducing and potentially stopping the medication, depending on factors such as the type of epilepsy, EEG findings, and the risk of seizure recurrence. This decision should always be made in collaboration with your specialist and with careful dose tapering over several months.
Weight changes with levetiracetam are uncommon. In clinical trials, both weight gain and weight loss were reported at similar low rates. Levetiracetam is generally considered weight-neutral compared with some other antiepileptic drugs that are more commonly associated with weight gain (such as valproate, pregabalin, and gabapentin) or weight loss (such as topiramate and zonisamide). If you notice significant weight changes during treatment, discuss them with your doctor.
Yes, levetiracetam can be taken with or without food. Food does not significantly affect the total amount of drug absorbed (bioavailability), although it may slightly delay the time to reach peak blood levels. Taking the tablets with food may help reduce stomach upset in some patients. The most important factor is to take the medication consistently at approximately the same times each day (usually morning and evening) to maintain stable blood levels for optimal seizure control.
Levetiracetam is frequently used in elderly patients and is often considered a preferred choice in this population due to its minimal drug interactions and simple pharmacokinetics. However, since kidney function naturally declines with age, the dose may need to be adjusted based on the patient's creatinine clearance. Elderly patients may also be more sensitive to the sedative effects of levetiracetam, increasing the risk of falls. A lower starting dose and slower titration are often recommended, and your doctor will monitor your kidney function to determine the appropriate dose.
References
This article is based on the following peer-reviewed and authoritative sources:
- European Medicines Agency (EMA). Levetiracetam — Summary of Product Characteristics. Last updated 2025. Available at: www.ema.europa.eu
- U.S. Food and Drug Administration (FDA). Keppra (levetiracetam) — Prescribing Information. Revised 2024. Available at: www.accessdata.fda.gov
- World Health Organization (WHO). WHO Model List of Essential Medicines — 23rd List, 2023. Available at: www.who.int
- Brodie MJ, et al. 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
- International League Against Epilepsy (ILAE). Updated ILAE evidence review of antiseizure medication efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2023;64(10):2605–2642.
- National Institute for Health and Care Excellence (NICE). Epilepsies in children, young people and adults. NICE guideline CG137. Last updated 2024. Available at: www.nice.org.uk
- Tomson T, 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
- Lynch BA, et al. The synaptic vesicle protein SV2A is the binding site for the antiepileptic drug levetiracetam. Proc Natl Acad Sci U S A. 2004;101(26):9861–9866. doi:10.1073/pnas.0308208101
- British National Formulary (BNF). Levetiracetam. NICE/BNF, 2025. Available at: bnf.nice.org.uk
- Mbizvo GK, et al. Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review. Cochrane Database Syst Rev. 2023;9:CD001901.
About Our Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, which includes board-certified specialists in neurology, epileptology, and clinical pharmacology. Our editorial process follows the GRADE evidence framework and adheres to international clinical guidelines from the World Health Organization (WHO), European Medicines Agency (EMA), U.S. Food and Drug Administration (FDA), International League Against Epilepsy (ILAE), and the National Institute for Health and Care Excellence (NICE).
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