Common uses of Keppra (levetiracetam)
Keppra is an anticonvulsant used to treat several seizure types in adults and children. In the U.S., it is FDA-approved for partial-onset seizures in patients 1 month of age and older, myoclonic seizures in patients 12 years and older with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients 6 years and older with idiopathic generalized epilepsy. Clinicians also use Keppra broadly because it has a favorable interaction profile compared with older antiseizure medications and can be combined with other agents when needed. Some patients may use Keppra as monotherapy, while others take it as add-on therapy to improve seizure control.
Keppra’s mechanism is distinct from many other anti-seizure drugs. It binds to synaptic vesicle protein 2A (SV2A), modulating neurotransmitter release and stabilizing neuronal activity. This mechanism contributes to its relatively low potential for drug–drug interactions and makes it a common choice when patients have complex medication regimens or comorbid conditions that require multiple therapies.
Dosage and directions for Keppra
Keppra is available as immediate-release (IR) tablets and oral solution taken twice daily, and as extended-release (XR) tablets taken once daily. Dosing is individualized by age, weight (in pediatrics), seizure type, kidney function, and response. Do not change your dose or stop Keppra without medical guidance, as abrupt changes can provoke seizures.
Adults and adolescents (IR): A common starting dose is 500 mg twice daily. Your clinician may increase by 500 mg twice daily every 2 weeks based on seizure control and tolerability, up to 1,500 mg twice daily (3,000 mg/day). For XR tablets, a typical starting dose is 1,000 mg once daily, titrated by 1,000 mg every 2 weeks to a maximum of 3,000 mg once daily.
Pediatric dosing (IR) is weight-based. A typical regimen begins at 20 mg/kg/day divided twice daily, then increases by 20 mg/kg/day at 2-week intervals to a usual maintenance dose of 40–60 mg/kg/day. For infants and young children, your pediatric neurologist will tailor the dose using the oral solution to allow precise measurement as your child grows.
Renal impairment requires dose adjustments. Because Keppra is primarily eliminated by the kidneys, clinicians reduce the total daily dose in mild, moderate, or severe renal dysfunction and administer supplemental doses after hemodialysis if needed. Your care team may check kidney function at baseline and periodically thereafter to guide dosing.
Administration tips: Take IR tablets or oral solution twice daily at consistent times. Take XR tablets once daily and swallow whole—do not split, crush, or chew. Keppra can be taken with or without food; taking it with food may lessen nausea in sensitive patients. Measure the oral solution with a marked oral syringe or dosing cup—do not use household spoons. If your dose changes, ask your pharmacist to confirm the new volume or tablet strength to avoid errors.
Precautions when using Keppra
Neuropsychiatric effects: Keppra may cause mood changes, irritability, agitation, anxiety, depression, or, rarely, aggression and psychosis. All antiseizure medications carry a warning about increased risk of suicidal thoughts and behaviors. Report new or worsening mood symptoms, behavioral changes, or self-harm thoughts immediately. Caregivers should monitor children and adolescents closely, especially during the first few months or after dose changes.
Sedation and coordination: Drowsiness, dizziness, and fatigue can occur. Until you know how Keppra affects you, avoid driving, operating machinery, climbing heights, or other tasks requiring full alertness. Alcohol and other sedatives can amplify these effects.
Allergy and serious rash: Hypersensitivity reactions—including angioedema and, rarely, severe cutaneous reactions such as Stevens–Johnson syndrome—have been reported. Seek urgent care for facial swelling, difficulty breathing, widespread rash, or skin blistering.
Pregnancy and breastfeeding: Many people successfully use levetiracetam during pregnancy under specialist supervision. If you are pregnant or planning pregnancy, do not stop Keppra suddenly. Discuss folic acid supplementation and monitoring with your clinician. Levetiracetam passes into breast milk; breastfeeding may be compatible for many families with pediatric monitoring for sedation or feeding issues. Decisions should be individualized with your care team.
Discontinuation: Stopping Keppra abruptly can increase seizure risk. Taper gradually over at least 1–2 weeks—or longer—under medical supervision, especially if you take multiple antiseizure medicines.
Other considerations: Tell your clinician about kidney disease, a history of mood disorders, prior serious rashes to medications, or any planned procedures. Keep consistent sleep, hydration, and medication schedules, as irregularities can lower seizure threshold.
Contraindications
Keppra is contraindicated in patients with known hypersensitivity to levetiracetam or any component of the formulation. Signs may include anaphylaxis, angioedema, or severe rash. Patients who experienced a serious adverse reaction to levetiracetam in the past generally should not be rechallenged and should discuss alternatives with a neurologist.
Possible side effects of Keppra
Common side effects include somnolence, fatigue, dizziness, headache, irritability, nervousness, and infection symptoms such as nasopharyngitis. Some people experience decreased appetite or gastrointestinal upset (nausea, vomiting). Many effects improve as your body adjusts or with dose optimization.
Behavioral and mood changes—particularly in children and adolescents—can manifest as agitation, emotional lability, hostility, or attention difficulties. Report persistent or severe symptoms; dose adjustment or adjunctive behavioral strategies may help. Rarely, Keppra can cause coordination problems or tremor.
Serious but uncommon reactions include severe rash, blood dyscrasias (such as low white blood cells), liver enzyme elevations, and suicidal ideation. Seek urgent care for rash with fever, uncontrolled agitation or confusion, severe weakness, unusual bleeding or bruising, or thoughts of self-harm. Your clinician may recommend labs in selected situations, especially if symptoms suggest hematologic or hepatic involvement.
Drug interactions with Keppra
Keppra has a low potential for clinically significant drug interactions because it undergoes minimal liver metabolism and does not meaningfully induce or inhibit CYP enzymes. It generally does not reduce the effectiveness of hormonal contraceptives and does not meaningfully alter warfarin pharmacokinetics. Nonetheless, inform your healthcare team about all prescription and over-the-counter medicines, vitamins, and herbal supplements you take.
CNS depressants (alcohol, benzodiazepines, opioids, sedating antihistamines) can increase drowsiness and impair coordination when combined with Keppra. Enzyme-inducing antiseizure medicines (such as carbamazepine, phenytoin, or phenobarbital) may modestly increase the clearance of levetiracetam, potentially requiring dose adjustments. Isolated reports describe altered levels of certain chemotherapeutic agents when co-administered; oncologists may monitor drug levels more closely in those scenarios.
Medications that lower seizure threshold—such as bupropion, tramadol, clozapine, or high-dose stimulants—may counteract seizure control; your prescriber will balance benefits and risks and adjust your plan as needed.
Missed dose
If you miss a dose of Keppra, take it as soon as you remember unless it is close to the time for your next scheduled dose. If it is nearly time for the next dose, skip the missed dose and resume your regular schedule. Do not double up. Consistency matters for seizure control, so consider using reminders, pill organizers, or smartphone alerts. If you miss multiple doses or experience a seizure after a missed dose, contact your care team for guidance.
Overdose
Symptoms of Keppra overdose may include marked drowsiness, agitation, confusion, decreased consciousness, breathing difficulties, or fainting. If an overdose is suspected, call your local emergency number or, in the U.S., Poison Help at 1-800-222-1222 immediately. Supportive care is the mainstay, and hemodialysis can remove a substantial portion of levetiracetam in severe cases, particularly in patients with kidney impairment. Bring medication bottles to the emergency department to help clinicians verify the amount and formulation taken.
Storage
Store Keppra tablets and oral solution at room temperature, ideally 20–25°C (68–77°F), away from moisture, heat, and direct light. Keep the bottle tightly closed and use the original child-resistant packaging. For the oral solution, use only the provided measuring device or a pharmacist-supplied oral syringe to ensure accurate dosing. Keep Keppra out of reach of children and pets. Do not use beyond the expiration date, and ask your pharmacist about proper disposal of unused or expired medication.
U.S. sale and prescription policy
In the United States, Keppra (levetiracetam) is a prescription-only medication. By law, pharmacies dispense it only pursuant to a valid prescription or medication order from a licensed prescriber after a clinical evaluation. Buying antiseizure medicines without an authorized prescriber’s involvement is unsafe and not permitted. If you are seeking fast, compliant access, the safest pathway is a same-day evaluation with a qualified clinician who can determine if Keppra is appropriate and issue the necessary order, followed by coordinated dispensing and follow-up.
HealthSouth Rehabilitation Hospital of Tallahassee offers a legal and structured solution for getting started on Keppra without a traditional paper prescription through on-site clinical assessment and medication management. In practical terms, that means a licensed provider evaluates you and, if appropriate, enters a medical order directly into the hospital’s system, allowing the pharmacy to dispense Keppra under medical supervision. This preserves patient safety and regulatory compliance while eliminating the need for you to carry a separate written prescription.
What to expect from this pathway: scheduling with neurology or an affiliated prescriber; review of your seizure history, current medicines, kidney function, and goals; selection of the right Keppra formulation (IR, XR, or oral solution) and dose; education on side effects and seizure safety; and pharmacy coordination for pickup and refills. Many patients can start therapy the same day if clinically appropriate. Bring identification, insurance information (if applicable), a medication list, and any prior records. Self-pay options and financial counseling may be available for those without insurance.
Refills and ongoing care are arranged through the hospital’s care team or your community clinician. Telehealth follow-ups may be available for dose adjustments or side-effect management. While online “no-Rx” offers exist, they risk counterfeit products, dosing errors, and legal issues. A supervised hospital-based process like that at HealthSouth Rehabilitation Hospital of Tallahassee maintains the safeguards you need for a chronic neurologic therapy: accurate diagnosis, right dose, authentic medication, and responsive follow-up.
