Keppra: Advanced Seizure Control with Proven Efficacy
Keppra
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| Product dosage: 500mg | |||
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Synonyms | |||
Keppra (levetiracetam) is an antiepileptic drug (AED) indicated for the adjunctive treatment of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children. As a second-generation medication, it offers a distinct mechanism of action, targeting synaptic vesicle protein 2A (SV2A), which is involved in the regulation of neurotransmitter release. Its favorable pharmacokinetic profile, including linear kinetics, minimal protein binding, and a lack of hepatic metabolism via the cytochrome P450 system, makes it a versatile and widely prescribed option in comprehensive epilepsy management protocols. Keppra is designed to provide neurologists and patients with a reliable therapeutic tool for reducing seizure frequency and improving quality of life.
Features
- Active ingredient: Levetiracetam
- Available in multiple formulations: immediate-release tablets (250 mg, 500 mg, 750 mg, 1000 mg), extended-release tablets (500 mg, 750 mg), and oral solution (100 mg/mL)
- Binds to synaptic vesicle protein 2A (SV2A) in the brain
- Rapid and nearly complete absorption after oral administration
- Minimal protein binding (<10%)
- Primarily excreted renally, with 66% of the dose recovered in urine as unchanged drug
- No active metabolites; not significantly metabolized by the liver
- Half-life of approximately 6–8 hours in adults, 5–6 hours in children
Benefits
- Effectively reduces the frequency of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures.
- Exhibits a favorable safety and tolerability profile compared to many older antiepileptic drugs.
- Lacks complex drug-drug interactions, making it suitable for patients on multiple medications.
- Available in various formulations to accommodate different patient needs, including pediatric and geriatric populations.
- Rapid onset of action allows for relatively quick titration to an effective therapeutic dose.
- Does not require routine therapeutic drug monitoring in most clinical scenarios.
Common use
Keppra is primarily used as adjunctive therapy in the management of epilepsy. It is approved for the treatment of partial onset seizures with or without secondary generalization in adults and children aged 1 month and older. It is also indicated for myoclonic seizures in adults and adolescents aged 12 years and older with juvenile myoclonic epilepsy, and for primary generalized tonic-clonic seizures in adults and children aged 6 years and older with idiopathic generalized epilepsy. In clinical practice, it is sometimes used off-label for other neurological conditions, such as neuropathic pain, migraine prophylaxis, and certain psychiatric disorders, though such uses should be guided by specialist evaluation.
Dosage and direction
Dosage must be individualized according to the patient’s clinical response, tolerability, and renal function. For adjunctive therapy in adults and adolescents (16 years and older) with partial onset seizures, the initial recommended dose is 500 mg twice daily. This can be increased by 500 mg twice daily every two weeks to a maximum recommended daily dose of 3000 mg. For myoclonic seizures in patients 12 years and older, the initial dose is 500 mg twice daily, with increases to 1500 mg twice daily as needed. For primary generalized tonic-clonic seizures in patients 6 years and older, the initial dose is 10 mg/kg twice daily, titrated to 30 mg/kg twice daily. Dosage adjustment is required in patients with renal impairment. The oral solution should be administered with the provided dosing syringe and may be diluted in a glass of water. Tablets should be swallowed whole and can be taken with or without food.
Precautions
Patients should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and unusual changes in mood or behavior. Neuropsychiatric adverse reactions, including agitation, aggression, anxiety, and psychosis, have been reported. Caution is advised when administering Keppra to patients with a history of psychiatric disorders. Abrupt withdrawal may increase seizure frequency; dose reduction should be gradual. Patients should be advised that Keppra may cause dizziness and somnolence, which could impair their ability to perform tasks requiring mental alertness, such as operating machinery or driving. Regular assessment of renal function is recommended, particularly in elderly patients or those with comorbid conditions.
Contraindications
Keppra is contraindicated in patients with a known hypersensitivity to levetiracetam, other pyrrolidine derivatives, or any of the excipients in the formulations. There are no other absolute contraindications based on clinical trials, but caution is warranted in populations with specific vulnerabilities, as outlined under Precautions.
Possible side effect
The most frequently reported adverse reactions (occurring in more than 5% of patients and more frequently than with placebo) include somnolence, asthenia, dizziness, and infection. Other common side effects may include:
- Headache
- Behavioral abnormalities (agitation, aggression, anxiety, irritability)
- Depression
- Nervousness
- Coordination difficulties (ataxia)
- Fatigue
- Nausea and vomiting Less common but serious adverse effects may include severe psychiatric symptoms, pancytopenia, Stevens-Johnson syndrome, and anaphylaxis. Any unusual or severe symptom should be reported to a healthcare provider immediately.
Drug interaction
Keppra has no known clinically significant pharmacokinetic interactions with other antiepileptic drugs such as carbamazepine, valproic acid, phenytoin, phenobarbital, or lamotrigine. It does not inhibit or induce cytochrome P450 enzymes. However, probenecid, a renal tubular secretion inhibitor, has been shown to reduce the renal clearance of the primary metabolite of levetiracetam, though the clinical significance is unknown. Caution should be exercised when co-administering with other central nervous system depressants, such as alcohol, benzodiazepines, or opioids, due to additive sedative effects.
Missed dose
If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed dose is not recommended, as it may increase the risk of adverse effects.
Overdose
Symptoms of overdose may include drowsiness, agitation, aggression, respiratory depression, and coma. There is no specific antidote for levetiracetam overdose. Management should consist of general supportive measures, including monitoring of vital signs and observation of clinical status. Hemodialysis may be effective in removing levetiracetam from the blood, with an extraction ratio of approximately 60%. In cases of suspected overdose, immediate medical attention should be sought.
Storage
Store at room temperature, between 15°C and 30°C (59°F and 86°F). Keep the oral solution in its original container and protect from light. Keep all medications out of the reach of children and pets. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations regarding any medical condition or therapeutic regimen. Do not initiate, adjust, or discontinue medication without the guidance of a licensed physician.
Reviews
Clinical studies and post-marketing surveillance have consistently demonstrated the efficacy and tolerability of Keppra in diverse patient populations. In pivotal trials, significant reductions in seizure frequency were observed compared to placebo. Many neurologists appreciate its predictable pharmacokinetics and low interaction potential. Patient-reported outcomes often highlight improved seizure control and quality of life, though some note behavioral side effects as a concern. Overall, it remains a cornerstone therapy in modern epileptology.