Keppra: Advanced Seizure Control for Improved Neurological Stability
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Synonyms | |||
Keppra (levetiracetam) is an antiepileptic drug (AED) indicated for the treatment of partial onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children. As a second-generation AED, it offers a favorable pharmacokinetic profile, minimal drug interactions, and a well-established efficacy and safety record. It is available in multiple formulations including tablets, oral solution, and intravenous injection, providing flexibility in administration across various clinical scenarios and patient needs.
Features
- Active ingredient: levetiracetam
- Available in tablet strengths: 250 mg, 500 mg, 750 mg, 1000 mg
- Oral solution: 100 mg/mL
- Intravenous injection: 100 mg/mL, compatible with common IV fluids
- Rapid and nearly complete absorption; not affected by food
- Linear pharmacokinetics with low protein binding (<10%)
- Primarily excreted renally; requires dosage adjustment in renal impairment
- Generic versions widely available, improving accessibility
Benefits
- Effectively reduces seizure frequency and severity in multiple epilepsy types
- Low potential for pharmacokinetic drug interactions due to minimal hepatic metabolism
- Generally well-tolerated with a predictable side effect profile
- Flexible dosing regimens and formulations support individualized treatment
- Suitable for use across a wide age range, including pediatric populations
- May be used as both monotherapy and adjunctive therapy
Common use
Keppra is primarily prescribed for the management of epilepsy. It is approved for adjunctive therapy in the treatment of partial onset seizures in adults and children from one month of age, myoclonic seizures in adults and adolescents 12 years of age and older with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy. It is also indicated as monotherapy for partial onset seizures in adults and children 4 years of age and older. Off-label, it is sometimes used for other neurological conditions such as neuropathic pain, migraine prophylaxis, and bipolar disorder, though evidence supporting these uses is less robust.
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 dose is 500 mg twice daily, which can be increased by 500 mg twice daily every two weeks to a maximum recommended daily dose of 3000 mg. For intravenous administration, the total daily dose and frequency are the same as for the oral formulation; it should be diluted and administered over 15 minutes. For pediatric patients, dosing is based on body weight. Patients with renal impairment require dose adjustment. Tablets may be taken with or without food.
Precautions
Patients should be monitored for neuropsychiatric adverse reactions such as agitation, hostility, depression, and suicidal ideation or behavior. Caution is advised when administering to patients with a history of psychiatric disorders. Dose reduction may be necessary in patients with renal impairment. Abrupt withdrawal may increase seizure frequency; discontinue gradually. Patients should be advised that Keppra may cause dizziness and somnolence, which could impair their ability to drive or operate machinery. Regular monitoring of hematological parameters may be considered during long-term therapy.
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, but it must be used with extreme caution and appropriate adjustment in patients with severe renal impairment.
Possible side effect
Common adverse reactions (occurring in >5% of patients) include somnolence, asthenia, dizziness, and infection. Less frequently, patients may experience behavioral effects such as agitation, anxiety, depression, emotional lability, or hostility. Other possible side effects include coordination difficulties, nausea, vomiting, diarrhea, and anorexia. Serious but rare side effects include severe dermatological reactions, pancytopenia, and anaphylaxis. Any new or worsening psychiatric symptoms should be promptly reported to a healthcare provider.
Drug interaction
Keppra has no known clinically significant pharmacokinetic interactions with other antiepileptic drugs such as carbamazepine, valproic acid, phenytoin, phenobarbital, or lamotrigine, nor with oral contraceptives, digoxin, or warfarin. However, potential pharmacodynamic interactions (e.g., additive CNS depressant effects with alcohol, benzodiazepines, or other sedatives) should be considered. Caution is advised when co-administering with other drugs that are excreted renally.
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 include general supportive measures, monitoring of vital signs, and ensuring adequate hydration. Hemodialysis may be effective in removing levetiracetam from the blood, with an extraction rate of approximately 50–60% over 4 hours. In cases of suspected overdose, immediate medical attention is required.
Storage
Store at room temperature (15–30°C or 59–86°F). Keep the container tightly closed and protect from moisture. The oral solution should be stored in the original container and used within 3 months of first opening; do not freeze. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. Dosage, indications, and safety information may change; refer to the latest prescribing information or consult a healthcare professional.
Reviews
Clinical studies and post-marketing surveillance indicate that Keppra is generally effective and well-tolerated. Many patients report a significant reduction in seizure frequency with a manageable side effect profile. However, some individuals, particularly children and adolescents, may experience behavioral side effects which can necessitate discontinuation or dose adjustment. Overall, it is considered a valuable option in the antiepileptic drug arsenal due to its efficacy, safety, and lack of significant drug interactions.