levetiracetam ER
Extended-release levetiracetam, also known by the brand name Keppra XR, is an anti-seizure medication. It's used to treat focal aware (partial-onset) seizures in people ages 12 years and older. This medication comes as a tablet that's taken by mouth once per day with or without food. The typical dosage ranges from 1,000 mg to 3,000 mg per day, depending on how well it keeps your seizures under control. Side effects include sleepiness and irritability.
What is Levetiracetam ER (Keppra XR)?
What is Levetiracetam ER (Keppra XR) used for?
Focal aware (partial-onset) seizures in people ages 12 years and older
How Levetiracetam ER (Keppra XR) works
Levetiracetam ER (Keppra XR) is an antiepileptic (another name for anti-seizure medication). It's not entirely clear how it works. But the medication seems to stop nerve cells in the brain from releasing certain chemicals. This helps calm your brain activity and prevent seizures from happening.
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What are the side effects of Levetiracetam ER (Keppra XR)?
Common Side Effects
- Flu-like symptoms (8%)
- Sleepiness (8%)
- Irritability (7%)
- Cold-like symptoms (7%)
Other Side Effects
- Dizziness
- Nausea
Serious Side Effects
- Unusual changes in mood, thoughts, or behavior
- Thoughts of hurting yourself or suicide
- Serious allergic reaction: hives; severe rash; trouble breathing; swelling of the face, mouth, lips, or throat
- Serious skin reaction: painful blisters, skin reddening, or skin peeling; with or without sore throat, fever, tiredness, or rash
- Low blood cell counts: severe weakness, fever, getting sick more often, bleeding or bruising more easily
Source: DailyMed
More on Levetiracetam ER (Keppra XR) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Aggressive or angry
change in personality
chills
crying
deep or fast breathing with dizziness
delusions of persecution, mistrust, suspiciousness, or combativeness
false or unusual sense of well-being
feeling of unreality
general feeling of discomfort or illness
headache
hoarseness
irregular heartbeat
irritability
joint pain
loss of appetite
lower back or side pain
mental depression
muscle aches and pains
numbness of the feet, hands, and around the mouth
painful or difficult urination
quick to react or overreact emotionally
rapidly changing moods
restlessness
sense of detachment from self or body
shaking
shivering
sleepiness or unusual drowsiness
stuffy or runny nose
sweating
trouble sleeping
unusual tiredness or weakness
vomiting
Less common
Bloody nose
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
clumsiness or unsteadiness
discouragement
dizziness or lightheadedness
double vision
feeling of constant movement of self or surroundings
feeling sad or empty
increase in body movements
loss of bladder control
loss of memory
mood or mental changes
outburst of anger
pain or tenderness around the eyes and cheekbones
problems with memory
redness or swelling in the ear
seizures
sensation of spinning
shakiness and unsteady walk
shakiness in the legs, arms, hands, or feet
tightness of the chest
trembling or shaking of the hands or feet
trouble concentrating
unsteadiness, trembling, or other problems with muscle control or coordination
Incidence not known
Attempts at killing oneself
being forgetful
bleeding gums
blistering, peeling, or loosening of the skin
blood in the urine or stools
bloody, black, or tarry stools
blurred vision
changes in vision
coma
confusion
dark urine
difficulty with moving
fast heartbeat
fever with or without chills
general feeling of tiredness or weakness
high fever
increased thirst
indigestion
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
muscle pains or stiffness
pains in the stomach, side, or abdomen, possibly radiating to the back
pale skin
pinpoint red spots on the skin
red skin lesions, often with a purple center
red, irritated eyes
skin rash, encrusted, scaly, and oozing
sores, ulcers, or white spots on the lips or in the mouth
stomach pain, continuing
swelling of the face, ankles, or hands
swollen glands
swollen joints
thoughts or attempts at killing oneself
trouble with balance
twitching, twisting, or uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
uncontrolled jerking or twisting movements of the hands, arms, or legs
uncontrolled movements of the lips, tongue, or cheeks
unexplained bleeding or bruising
unusual bleeding or bruising
upper right abdominal or stomach pain
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Loss of strength or energy
muscle pain or weakness
tender, swollen glands in the neck
trouble swallowing
unusual weak feeling
voice changes
Less common
Body aches or pain
burning, dry, or itching eyes
change in the color of the skin
congestion
cough increased
Incidence not known
Hair loss or thinning of the hair
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Levetiracetam ER (Keppra XR)
Pros
Taken by mouth once a day with or without food
Doesn't cause weight gain
Usually tolerated well
Cons
Can't crush tablets and doesn't have a liquid option
Not for children younger than 12 years of age
Can cause changes in behavior or mood
Pharmacist tips for Levetiracetam ER (Keppra XR)
Take levetiracetam ER (Keppra XR) once a day with or without food. If it upsets your stomach, it might be helpful to take the medication with food next time.
Swallow levetiracetam ER (Keppra XR) whole. Don't crush, cut, or chew the tablet to avoid too much medication to get released into the body too quickly. If you or your child has trouble swallowing the tablet whole, ask the prescriber about other options. They might suggest switching to the immediate-release form of the medication, which has a liquid version, or to a different antiepileptic.
It's common to feel sleepy and dizzy while taking levetiracetam ER (Keppra XR). Don't drive or do anything you need to focus until you know how this medication affects you.
It's a good idea to avoid alcohol or limit how much you drink while taking levetiracetam ER (Keppra XR). Alcohol can make side effects like sleepiness and dizziness more intense.
Some people can have changes in mood, thoughts, and behavior while taking levetiracetam ER (Keppra XR). Some people might be more irritable or aggressive. But others might also be more anxious, sad, or moody. Talk to your prescriber if you notice any mood or behavior changes that worry you.
Levetiracetam ER (Keppra XR) can raise the risk of having suicidal thoughts. Call 911 as soon as possible if you or your loved ones notice that you have thoughts of harming yourself.
Don't lower your dose or suddenly stop taking levetiracetam ER (Keppra XR) without talking to your prescriber first. Doing this too fast can make your seizures come back or get worse. Follow your prescriber's instructions to lower your dose slowly over time to stop the medication completely. Keep an eye on how well your seizures are controlled while you work with your prescriber to stop the medication.
Frequently asked questions about Levetiracetam ER (Keppra XR)
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What are the risks and warnings for Levetiracetam ER (Keppra XR)?
Levetiracetam ER (Keppra XR) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Abnormal mood, thoughts, or behavior
Risk factors: Children | History of mental health problems, such as depression, schizophrenia, or bipolar disorder
Levetiracetam ER (Keppra XR) can sometimes cause changes in mood, thoughts, or behavior. It can make some people irritable, aggressive, and possibly anxious or paranoid. Other people might feel sad or have mood swings.
If you or your loved ones see a change in your mood or thoughts while taking levetiracetam ER (Keppra XR), let your prescriber know. Parents should also talk to the prescriber if they see any unusual mood or behavior changes in their child during treatment.
Suicidal thoughts or behavior
Risk factors: Taking other anti-seizure medications
Antiepileptic medications, including levetiracetam ER (Keppra XR), can raise your risk of having thoughts of suicide or harming yourself. This risk can appear as early as 1 week after you start taking the medication.
Speak with your prescriber if you or your loved ones notice any worsening signs of depression while you're taking levetiracetam ER (Keppra XR). Call 911 right away if you or anyone around you notices that you have suicidal thoughts or behavior.
Difficulty with speech, movement, and concentration
Risk factors: Taking high doses of levetiracetam ER (Keppra XR) | Taking other medications that can cause sleepiness or dizziness
It's possible for levetiracetam ER (Keppra XR) to cause side effects like trouble focusing, speech or language problems, and problems with coordination. It can also make people feel dizzy, sleepy, and tired. This can lower your ability to think, react, and focus.
You're more likely to have these side effects if you take other medications that also make you sleepy, dizzy, or tired. Examples include benzodiazepines, muscle relaxants, and sleep medications.
Be sure you know how levetiracetam ER (Keppra XR) affects you before driving or doing anything that needs your full attention. Talk to your healthcare team if you feel too sleepy or have trouble with coordination while taking this medication.
Serious allergic reactions and skin reactions
Severe, life-threatening allergic reactions to levetiracetam ER (Keppra XR) can happen. They can include face swelling, throat closing, and anaphylaxis. It can also cause a rare reaction called drug reaction with eosinophilia and systemic symptoms (DRESS). In addition, levetiracetam ER (Keppra XR) can cause serious skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
Allergic reactions can happen at any time while taking levetiracetam ER (Keppra XR). For some, serious skin reactions happened within the first 2 to 3 weeks of taking the medication. And for others, they happened several months later.
Stop taking levetiracetam ER (Keppra XR) and get medical attention right away if you have painful blisters, red skin, or skin peeling. These skin reactions can happen with or without sore throat, fever, tiredness, or rash. Call 911 if your face swells up or if you have trouble breathing.
Withdrawal seizures
Risk factors: Stopping levetiracetam ER (Keppra XR) suddenly
Don't stop taking levetiracetam ER (Keppra XR) without talking to your prescriber first. Stopping antiepileptic medications suddenly can cause seizures to come back.
If you need to stop taking levetiracetam ER (Keppra XR), your prescriber will tell you how to do this in a safe way. Most of the time, they'll slowly lower your dose before you can stop taking it completely.
Low blood cell counts
Although rare, levetiracetam ER (Keppra XR) can lower your blood cell counts. This can sometimes put you at risk for anemia, infection, and bleeding or bruising. Tell your care team if you have any symptoms like fever, chills, shortness of breath, weakness, or frequent infections. Also let them know about any unusual bruising or bleeding. These can be symptoms of a low blood cell count. Your prescriber can check if they're low with a blood test called a complete blood count (CBC).
Seizure control during pregnancy
The levels of levetiracetam ER (Keppra XR) in the body can go down during pregnancy, especially in the third trimester. When the levels are lower, the medication might not work as well to control seizures.
If you're pregnant, you should follow up with your prescriber more often. They'll check how well levetiracetam ER (Keppra XR) is working for you during pregnancy. Your dose might need to get adjusted later in your pregnancy to help keep seizures under control.
Levetiracetam ER (Keppra XR) dosage forms
Typical dosing for Levetiracetam ER (Keppra XR)
For adults and children 12 years and older weighing 110 lbs or more: The typical dose ranges from 1,000 mg to 3,000 mg by mouth once per day.
Your dose might differ if you have kidney problems.
More on Levetiracetam ER (Keppra XR) dosage forms
Interactions between Levetiracetam ER (Keppra XR) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Calcifediol
- Methotrexate
- Orlistat
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Carbamazepine
- Ginkgo
How much does Levetiracetam ER (Keppra XR) cost?
What are alternatives to Levetiracetam ER (Keppra XR)?
Focal aware (partial-onset) seizures in people ages 12 years and older
Partial-onset seizures (or focal aware seizures)
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
What is the latest news about Levetiracetam ER (Keppra XR)?
Levetiracetam ER (Keppra XR) images
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References
Best studies we foundAbou-Khalil, B. (2008). Levetiracetam in the treatment of epilepsy. Neuropsychiatric Disease and Treatment.
Berlin, M., et al. (2019). Therapeutic levetiracetam monitoring during pregnancy: "Mind the gap". Therapeutic Advances in Chronic Disease.
Drugs and Lactation Database (LactMed®). (2024). Levetiracetam. National Institute of Child Health and Human Development.
Joshi, C. (2020). Epilepsy generalized tonic clonic seizures alone. Epilepsy Foundation.
Kienitz, R., et al. (2022). Benzodiazepines in the management of seizures and status epilepticus: A review of routes of delivery, pharmacokinetics, efficacy, and tolerability. CNS Drugs.
Kiriakopoulos, E. (n.d.). Focal aware seizures (simple partial seizures). Epilepsy Foundation.
Koubeissi, M. (2013). Levetiracetam: More evidence of safety in pregnancy. Epilepsy Currents.
Kumar, A., et al. (2023). Levetiracetam. StatPearls.
U.S. Food and Drug Administration. (2023). FDA Drug Safety Communication: FDA warns of rare but serious drug reaction to the antiseizure medicines levetiracetam (Keppra, Keppra XR, Elepsia CR, Spritam) and clobazam (Onfi, Sympazan).
UCB, Inc. (2024). Keppra XR- levetiracetam tablet, film coated, extended release [package insert]. DailyMed.
Ulloa, C. M., et al. (2009). Review of levetiracetam, with a focus on the extended release formulation, as adjuvant therapy in controlling partial-onset seizures. Neuropsychiatric Disease and Treatment.
Verrotti, A., et al. (2015). The adverse event profile of levetiracetam: A meta-analysis on children and adults. Seizure.
Wirrell, E., et al. (2019). Juvenile myoclonic epilepsy. Epilepsy Foundation.
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