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Levetiracetam

1. About levetiracetam

Levetiracetam is a medicine used to treat epilepsy.

Levetiracetam is available on prescription.

It comes as tablets, a liquid and granules. These can be swallowed directly from the packet or mixed with water to make a drink.

2. Key facts

  • It's usual to take levetiracetam once or twice a day. You can take it with or without food.
  • The most common side effects of levetiracetam are headaches, sleepiness and a blocked nose or itchy throat.
  • It can take a few weeks for levetiracetam to work. You may still have fits (seizures) during this time.
  • The most common brand names of levetiracetam are Desitrend and Keppra.

3. Who can and can't take levetiracetam

Levetiracetam can be taken by adults and children aged 1 month and over.

Levetiracetam is not suitable for some people.

To make sure levetiracetam is safe for you, tell your doctor if you:

  • have ever had an allergic reaction to levetiracetam or other medicines in the past
  • have kidney problems
  • have had a low mood (depression) or thoughts of harming or killing yourself in the past
  • are pregnant, or planning to become pregnant
  • have an intolerance to some sugars - some brands of levetiracetam liquid contain maltitol
  • have ever had an allergic reaction to preservatives and artificial food colourings like sunset yellow (E110) - some brands of levetiracetam contain these

4. How and when to take it

Levetiracetam is a prescription medicine. It's important to take it as advised by your doctor.

How much will I take?

The usual dose of levetiracetam to treat epilepsy in adults and older children (aged 12 years and over) is 250mg to 3,000mg a day, taken as 1 or 2 doses, but the exact dose may depend on your weight.

The dose for younger children (aged 1 month to 12 years) varies depending on their weight.

How to take it

You can take levetiracetam with or without food.

If you take it twice a day, try to space your doses evenly through the day - for example, first thing in the morning and in the evening.

Tablets - swallow whole with a drink of water, milk or juice. Do not chew them.

Liquid - can be swallowed whole or mixed into a glass of water, milk or juice. This comes with a syringe to help you measure it. If you do not have a syringe, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give you the right amount.

Granules - can be swallowed straight from the packet or mixed with food or water. Do not chew them. Drink some water after you have swallowed them.

Will my dose go up or down?

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few weeks.

Once you find a dose that suits you, it'll usually stay the same.

What if I forget to take it?

If you take levetiracetam and miss a dose:

  • once a day - take the missed dose as soon as you remember. If it's less than 12 hours before the next dose is due, leave out the missed dose and take your next dose as normal.
  • twice a day - take the missed dose as soon as you remember. If it's less than 8 hours before the next dose is due, leave out the missed dose and take your next dose as normal.

Do not take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

It's important to take this medicine regularly. Missing doses may trigger a seizure.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too much levetiracetam by accident can cause serious side effects.

Urgent advice: Call your doctor or go to A&E if you take too much levetiracetam and:

  • feel sleepy or less alert
  • feel agitated or aggressive
  • have problems breathing
  • pass out

If you need to go to an A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the levetiracetam packet or the leaflet inside it, plus any remaining medicine, with you.

5. Side effects

Like all medicines, levetiracetam can cause side effects, although not everyone gets them.

Common side effects

These common side effects may happen in more than 1 in 100 people. They're usually mild and go away by themselves.

Keep taking the medicine, but talk to your pharmacist or doctor if these side effects bother you or do not go away:

  • a blocked nose or itchy throat
  • feeling drowsy, sleepy or dizzy
  • headaches
  • aggression, or feeling irritable or agitated
  • feeling or being sick (nausea or vomiting)

Serious side effects

Very few people taking levetiracetam have serious problems.

Tell a doctor straight away if you have a serious side effect, including:

  • flu-like symptoms and a rash on the face, or a rash that spreads or forms blisters - these can be signs of a rare serious skin condition called Stevens-Johnson syndrome
  • seizures getting worse
  • passing very little pee, feeling tired or confused, or having swollen legs, ankles or feet - these could be signs of kidney problems
  • signs of serious mental changes, or someone around you notices signs of confusion, sleepiness, loss of memory, forgetfulness, abnormal behaviour or uncontrolled movements
  • thoughts of harming or killing yourself - a small number of people taking levetiracetam have had suicidal thoughts

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to levetiracetam.

Urgent advice: Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction.

A serious allergic reaction is an emergency.

These are not all the side effects of levetiracetam.

For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • a blocked nose or itchy throat- if it's bothering you, ask your pharmacist for something to help your symptoms. If they do not wear off, tell your doctor
  • feeling drowsy, sleepy or dizzy - as your body gets used to levetiracetam, these side effects should wear off. Do not drive, ride a bike, or operate machinery until you feel more alert. If they do not wear off within a week or two, your doctor may reduce your dose or increase it more slowly. If that does not work, you may need to switch to a different medicine
  • headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. If it's a problem, ask your pharmacist to recommend a painkiller. Talk to your doctor if your headaches last longer than a week or are severe.
  • aggression, or feeling irritable or agitated - talk to your doctor if you have any of these side effects.
  • feeling or being sick - stick to simple meals and do not eat rich or spicy food. It might help to take your levetiracetam after a meal or snack. If you're being sick, take small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any medicines to treat vomiting without speaking to a pharmacist or doctor. Speak to a doctor if your symptoms get worse or last longer than a week.

7. Pregnancy and breastfeeding

There's no firm evidence that levetiracetam is harmful to an unborn baby.

But for safety, your doctor will only advise you to take it in pregnancy if the benefits of the medicine outweigh the risks.

It's very important that your epilepsy is treated during pregnancy as seizures can harm you and your unborn baby.

If you become pregnant while taking levetiracetam, tell your doctor or nurse straight away.

Do not stop the medicine without talking to your doctor first.

If you're pregnant, or trying to get pregnant, and taking levetiracetam, you're recommended to take a higher dose of folic acid, a vitamin that helps your baby grow normally.

Your doctor might prescribe a high dose of 5mg a day for you to take when you're trying to get pregnant, and during the first 12 weeks of pregnancy.

For more information about how levetiracetam can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.

Levetiracetam and breastfeeding

If your doctor or health visitor says your baby is healthy, levetiracetam can be taken while you're breastfeeding.

Levetiracetam passes into breast milk in small amounts.

There have been some reports of side effects in breastfed babies, including not feeding well.

But in most cases babies do not get any side effects.

If your baby's not feeding as well as usual, seems unusually sleepy, or you have any other concerns about them, talk to your pharmacist, health visitor or doctor as soon as possible.

Non-urgent advice: Talk to your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines and levetiracetam interfere with each other and increase your side effects.

Your doctor may need to change your dose of levetiracetam if you're taking any of these medicines.

Tell your pharmacist or doctor if you're taking:

  • macrogol, a laxative
  • other epilepsy medicines, such as carbamazepine, lamotrigine, oxcarbazepine, phenobarbital and phenytoin
  • methotrexate, a medicine that can be used to treat arthritis and other conditions

Mixing levetiracetam with herbal remedies and supplements

There might be a problem taking some herbal remedies and supplements alongside levetiracetam, especially ones that cause sleepiness or dizziness.

Ask your pharmacist for advice.

Important

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does levetiracetam work?

Brain cells normally "talk" to each other using electrical signals and chemicals.

Seizures can happen when the brain cells are not working properly or working faster than usual.

Levetiracetam slows down these electrical signals to stop seizures.

Levetiracetam also works differently from most epilepsy medicines.

It joins with a protein that's involved with releasing certain chemicals in the brain. The exact way this works is not fully known.

How long does it take to work?

It usually takes a few weeks for levetiracetam to work properly.

This is because the dose of levetiracetam needs to be increased slowly.

You may still have seizures during this time.

How long will I take it for?

Levetiracetam is a relatively new medicine.

At the moment, there's no evidence to show it has lasting harmful effects if you take it for many months or years.

Are there similar medicines?

Brivaracetam is very similar to levetiracetam.

They work in the same way, but these medicines are given at different doses.

If you decide to try brivaracetam instead, your doctor will explain how to come off levetiracetam safely.

Is it safe to take levetiracetam for a long time?

Levetiracetam is a relatively new medicine.

At the moment, there's no evidence to show it has lasting harmful effects if you take it for many months or years.

Are there similar medicines?

There are lots of medicines for treating epilepsy, but they work in different ways.

The choice will depend on the type of seizures you have.

Your doctor will discuss the best medicine for you.

Brivaracetam is very similar to levetiracetam. It works in the same way, but can be given at different doses.

If you decide to try brivaracetam instead, your doctor will explain how to switch medicines safely.

How does it compare with other medicines?

Other medicines to treat epilepsy include:

It's not possible to say that one works better than the other.

It varies from person to person, and depends on the type of seizures and how often you have them.

Your doctor will decide on the medicine that's best for you.

They'll look at your age, gender, the medicines you're already taking and any other health problems you may have.

It's usual to try to treat epilepsy using a single medicine.

If this medicine is not working well or you're getting side effects, your doctor will generally try you on a different one.

If a single medicine is not preventing your seizures, your doctor may recommend taking 2 or more epilepsy medicines at the same time.

Levetiracetam works for quite a few different types of epilepsy.

If it's giving you side effects or you're worried it's not suitable for you, ask your doctor or specialist to recommend a different medicine.

Can I switch to a different medicine?

If you're switching medicines, it's very important to do it exactly as your doctor tells you to.

If you want to switch, you'll usually start taking the new medicine at a low dose and slowly build up the dose while you're still taking levetiracetam.

It's not always important to stay on the same brand, but ask your doctor.

If your epilepsy has been hard to control in the past and the brand of levetiracetam you're now taking is working well for you, your doctor may recommend you stay on the same one.

Talk to your doctor if you have been asked to switch to a different brand of levetiracetam and are worried about that.

Can I come off levetiracetam?

If you're taking levetiracetam for epilepsy, stopping it suddenly can cause seizures.

Coming off levetiracetam should be done very slowly and might take a few months.

If you get a serious side effect, such as a severe skin condition, your doctor may tell you to stop taking levetiracetam straight away, even if you have epilepsy.

Important

Do not stop taking levetiracetam without talking to your doctor first.

What is 'Keppra rage' and how may this affect my mood?

Keppra is a brand of levetiracetam.

Levetiracetam can sometimes cause changes in your mood or behaviour. You may feel angry, agitated or depressed.

This side effect does not affect everyone, but it's important to tell your doctor if you have any changes in your mood, feel depressed or have thoughts of harming yourself.

Do I need to take vitamin B alongside my levetiracetam?

Some people take vitamin B6 (also known as pyridoxine) alongside levetiracetam to reduce the chances of mood changes.

A few studies have reported that vitamin B6 might be helpful, but we do not have enough information to be sure.

If you wish to take any vitamins alongside your prescribed medicines, it's important to speak to your pharmacist or doctor, who can advise you what you can take.

Will it affect my contraception?

Levetiracetam does not affect any type of contraception, including the combined pill and emergency contraception.

Will it affect my fertility?

It's not thought that levetiracetam affects female fertility.

Some men with epilepsy and taking epilepsy medicines may have reduced levels of testosterone.

Some epilepsy medicines also reduce the amount of sperm you produce or affect the quality of it.

This does not affect everyone, but could make you less fertile.

Talk to your doctor if you have any concerns.

Does levetiracetam cause weight loss?

Levetiracetam does not usually affect weight at all.

Can I get epilepsy medicines for free?

If you have epilepsy, you're entitled to free prescriptions for all of your medicines (not just your epilepsy ones).

To claim your free prescriptions, you'll need a medical exemption certificate.

The application form for the medical exemption certificate is called FP92A. You can get this from your doctor's surgery.

You'll need to fill in the form, then your doctor will sign it and send it off.

Can I drink alcohol with it?

Yes, you can drink alcohol with levetiracetam.

But it may make you feel sleepy or tired, and alcohol and hangovers can bring on seizures in some people with epilepsy.

During the first few days of taking levetiracetam, it's best to stop drinking alcohol until you see how the medicine affects you.

If you do drink, try not to have more than the recommended guidelines of up to 14 units of alcohol a week.

A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Is there any food or drink I need to avoid?

No, you can eat and drink normally while taking levetiracetam.

Can I drive or ride a bike with it?

You may feel sleepy, tired or dizzy when you first start taking levetiracetam or when the dose is increased.

If this happens to you, do not drive or ride a bike or operate machinery until you feel more alert.

It can also affect your vision. Do not drive if your vision is affected.

If you have epilepsy, you're not allowed to drive until you have had no seizures for 1 year.

You're also not allowed to drive for 6 months if you change your epilepsy medicine.

GOV.UK has more information on epilepsy and driving

Page last reviewed: 25 February 2019
Next review due: 25 February 2022