Keppra (levetiracetam)
Also marketed as Keppra XR and Spritam. An approved treatment for Focal Epilepsy.
The same compound appears under different names depending on the context. Here is how to identify Levetiracetam wherever you encounter it, plus the key facts at a glance.
- Generic name
- Levetiracetam
- Brand names
- Keppra, Keppra XR, Spritam
- Development code
- UCB L059
- Drug class
- SV2A ligand (antiseizure medication)
- Manufacturer
- UCB
- How it's taken
- Taken by mouth as a tablet or liquid, usually twice a day (an extended-release form, Keppra XR, is once daily).
One of the most widely prescribed add-on seizure medications in the world. Levetiracetam works through a unique target in the brain (the SV2A protein), starts working quickly, and needs almost no dose ramp-up, which is why it is often reached for first.
Where Levetiracetam fits
Frequently a first-choice add-on, and sometimes first-line, because it acts fast, needs little titration, and has very few drug interactions. Its main drawback is irritability or mood changes in some people.
How Levetiracetam works
During a focal seizure, a cluster of brain cells fires electrical signals too fast and in unison. Levetiracetam attaches to a protein on the tiny sacs (vesicles) that store the brain's chemical messengers, called SV2A. By binding there, it smooths out the release of those messengers so overexcited nerve cells are less likely to fire off a seizure.
This is a different target from most older seizure drugs, which block sodium channels or boost the calming GABA system. Because levetiracetam does not rely on those pathways, it can be combined with other drugs and generally causes less cognitive slowing[2].
Mechanism: Binds synaptic vesicle glycoprotein 2A (SV2A) to modulate neurotransmitter release and dampen abnormal neuronal firing
Side effects and safety
The most common side effects are sleepiness, weakness, dizziness, and, importantly, irritability, agitation, or mood and behavior changes, which affect a meaningful minority of patients and sometimes lead people to switch drugs. Some patients find that a vitamin called B6 (pyridoxine) helps blunt the irritability, though this should be discussed with a doctor.
Like all antiseizure medications, levetiracetam carries a class warning about a small increased risk of suicidal thoughts, so any new depression or mood change should be reported promptly. The label also warns about serious reactions that need urgent care: severe allergic reactions (anaphylaxis) with swelling of the face, lips, tongue or throat; serious skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis), so a new rash should be reported right away; and a body-wide allergic reaction called DRESS (fever, rash, swollen glands) that can be fatal. It can also lower blood cell counts and cause psychotic symptoms. Other label warnings cover sleepiness, trouble with coordination, higher blood pressure in children under 4, lower drug levels during pregnancy, and seizures if it is stopped suddenly[1].
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Levetiracetam
Taken by mouth as a tablet or liquid, usually twice a day (an extended-release form, Keppra XR, is once daily). A dissolvable version (Spritam, made by Aprecia Pharmaceuticals rather than UCB) is available for people who have trouble swallowing pills. Keppra (tablets, or the liquid for young children) is approved for focal seizures from 1 month of age, while Keppra XR is approved from age 12 and Spritam from age 4 in children weighing more than 20 kg (about 44 pounds). Little or no gradual dose build-up is needed, so it can be started closer to a full dose than most seizure medicines[1].
Availability and cost
Generic versions may be available at a lower cost. Ask your pharmacist.
Help paying for Keppra
Pick your insurance to see which help fits. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE; charity funds are the usual route there.
No drugmaker assistance program for this medicine is published on the maker's official pages.
Good to know: Widely available as generic. Spritam is made by Aprecia, not UCB, and has its own savings program (spritam.com). Keppra is not on UCB's current copay or patient assistance lists.
- From a charity · The Assistance FundEpilepsy fundWaitlist
Pays for: Copays, coinsurance, deductibles and other health-related expenses.
The foundation says: “WAITLIST — Accepting Waitlist Patients. TAF is currently accepting requests to join the enrollment waitlist for this program. Waitlists a…”
Clinical trial results
Levetiracetam was approved by the FDA in 1999 as an add-on treatment for focal (partial-onset) seizures in adults, based on placebo-controlled trials showing significant reductions in seizure frequency. It has since been approved for additional seizure types and for children, and decades of real-world use have made it one of the best-characterized seizure drugs available[2].
Development history
Levetiracetam was developed by the Belgian company UCB and approved in 1999 under the brand name Keppra. It was notable because it failed the traditional animal screening tests that most seizure drugs pass, yet proved highly effective in humans, which eventually led scientists to discover its unique SV2A mechanism. It is now available as an inexpensive generic and remains a global mainstay of epilepsy care[2].
Explore Focal Epilepsy trials
Other Focal Epilepsy treatments
Common questions about Levetiracetam
▸What is Levetiracetam (Keppra)?
One of the most widely prescribed add-on seizure medications in the world. Levetiracetam works through a unique target in the brain (the SV2A protein), starts working quickly, and needs almost no dose ramp-up, which is why it is often reached for first.
▸How does Levetiracetam work?
During a focal seizure, a cluster of brain cells fires electrical signals too fast and in unison. Levetiracetam attaches to a protein on the tiny sacs (vesicles) that store the brain's chemical messengers, called SV2A. By binding there, it smooths out the release of those messengers so overexcited nerve cells are less likely to fire off a seizure.
This is a different target from most older seizure drugs, which block sodium channels or boost the calming GABA system. Because levetiracetam does not rely on those pathways, it can be combined with other drugs and generally causes less cognitive slowing[2].
▸What are the side effects of Levetiracetam?
The most common side effects are sleepiness, weakness, dizziness, and, importantly, irritability, agitation, or mood and behavior changes, which affect a meaningful minority of patients and sometimes lead people to switch drugs. Some patients find that a vitamin called B6 (pyridoxine) helps blunt the irritability, though this should be discussed with a doctor.
Like all antiseizure medications, levetiracetam carries a class warning about a small increased risk of suicidal thoughts, so any new depression or mood change should be reported promptly. The label also warns about serious reactions that need urgent care: severe allergic reactions (anaphylaxis) with swelling of the face, lips, tongue or throat; serious skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis), so a new rash should be reported right away; and a body-wide allergic reaction called DRESS (fever, rash, swollen glands) that can be fatal. It can also lower blood cell counts and cause psychotic symptoms. Other label warnings cover sleepiness, trouble with coordination, higher blood pressure in children under 4, lower drug levels during pregnancy, and seizures if it is stopped suddenly[1].
▸How is Levetiracetam taken?
Taken by mouth as a tablet or liquid, usually twice a day (an extended-release form, Keppra XR, is once daily). A dissolvable version (Spritam, made by Aprecia Pharmaceuticals rather than UCB) is available for people who have trouble swallowing pills. Keppra (tablets, or the liquid for young children) is approved for focal seizures from 1 month of age, while Keppra XR is approved from age 12 and Spritam from age 4 in children weighing more than 20 kg (about 44 pounds). Little or no gradual dose build-up is needed, so it can be started closer to a full dose than most seizure medicines[1].
▸Is Levetiracetam FDA approved?
Yes, Levetiracetam (Keppra) is FDA approved (1999) for the treatment of Focal Epilepsy.
▸What is levetiracetam (Keppra) used for?
Levetiracetam (Keppra) was approved by the FDA in 1999 as an add-on treatment for focal (partial-onset) seizures in adults, based on placebo-controlled trials showing significant reductions in seizure frequency. It has since been approved for additional seizure types and for children, and Keppra is approved for focal seizures from 1 month of age. It is one of the most widely prescribed add-on seizure medications in the world and is available as an inexpensive generic. [2][1]
▸How does levetiracetam work?
Levetiracetam attaches to a protein called SV2A on the tiny sacs (vesicles) that store the brain's chemical messengers, smoothing out their release so overexcited nerve cells are less likely to fire off a seizure. This is a different target from most older seizure drugs, which block sodium channels or boost the calming GABA system. Because levetiracetam does not rely on those pathways, it can be combined with other drugs and generally causes less cognitive slowing. [2]
▸What are the side effects of levetiracetam?
The most common side effects of levetiracetam are sleepiness, weakness, dizziness, and irritability, agitation or mood and behavior changes, which affect a meaningful minority of patients and sometimes lead people to switch drugs. Like all antiseizure medications, it carries a class warning about a small increased risk of suicidal thoughts, so any new depression or mood change should be reported promptly. The label also warns about severe allergic reactions, serious skin reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis), a body-wide reaction called DRESS, lower blood cell counts, psychotic symptoms, and seizures if it is stopped suddenly. [1]
▸How is levetiracetam taken?
Levetiracetam is taken by mouth as a tablet or liquid, usually twice a day, while the extended-release form, Keppra XR, is taken once daily and is approved from age 12. A dissolvable version called Spritam, made by Aprecia Pharmaceuticals, is approved from age 4 in children weighing more than 20 kg (about 44 pounds) for people who have trouble swallowing pills. Little or no gradual dose build-up is needed, so levetiracetam can be started closer to a full dose than most seizure medicines. [1]
Sources and references
Every factual claim on this page is drawn from the public sources listed below. Click any reference to open the original document.
- U.S. Food and Drug Administration (Drugs@FDA). KEPPRA (levetiracetam) tablets, oral solution, Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021035s099,021505s038lbl.pdf
- PMC / Neuropsychiatric Disease and Treatment. Review of levetiracetam as adjuvant therapy in controlling partial-onset seizures. https://pmc.ncbi.nlm.nih.gov/articles/PMC2747386/