9 Levetiracetam (Keppra) Side Effects and How to Manage Them

Levetiracetam (Keppra) is a common antiepileptic drug (AED) used to treat different types of seizures. If your prescriber has added levetiracetam to your epilepsy treatment regimen, you likely have questions about its side effects.

Similar to other AEDs, levetiracetam can make you feel tired and dizzy, especially within the first month. But it has a few other notable side effects, too. Some are mild, such as headaches and nausea. However, serious levetiracetam side effects can also happen. Knowing what to watch for and what steps you should take can help keep you safe during treatment.

Levetiracetam side effects at a glance

Levetiracetam side effects are often mild and can be managed at home. Others are less common but may require assistance from a healthcare professional or even emergency medical care in severe cases. 

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Common levetiracetam side effects include:

• Weakness

• Drowsiness

• Headache

• Irritability

• Cold and flu symptoms

• Dizziness

• Nausea

Less common but potentially serious side effects include:

• Mood and behavioral changes

• Severe skin reactions

• Blood disorders

Below, we’ll take a look at nine levetiracetam side effects and steps you can take if you experience them.  

1. Weakness

You may feel unusually weak or fatigued while taking levetiracetam. It’s one of the most common levetiracetam side effects. Fatigue is common with epilepsy treatment, but one study found that it’s more commonly reported by women. It also seems to be more common with levetiracetam compared to other AEDs.

During clinical trials, people usually reported weakness within the first 4 weeks of starting levetiracetam. This side effect should start to improve as your body gets used to treatment. But you should tell your prescriber if it’s severe, not improving, or affecting your daily activities.

2. Drowsiness

Drowsiness is also one of the most common levetiracetam side effects. Similar to weakness or fatigue, feelings of drowsiness usually occur within the first 4 weeks of starting levetiracetam. This side effect may be worse if you’re also taking other medications that cause drowsiness. 

Since levetiracetam can make you feel sleepy, it’s best to avoid performing tasks that require you to be alert until you see how the medication affects you. It’s also a good idea to avoid or minimize alcohol with levetiracetam since it can make the drowsiness worse. And alcohol can increase the risk of seizures, too.

Contact your prescriber if drowsiness is persistent or affects your ability to complete daily tasks.

3. Headache

Headaches are also possible with levetiracetam. But people who didn’t receive levetiracetam during clinical trials also experienced headaches. And having epilepsy can increase your risk of headaches in general. This includes headaches before or after a seizure and migraine headaches.

If your headaches are persistent or start to interfere with your day-to-day activities, talk to your healthcare team. Take note of when your headaches occur, since this can help them figure out the cause and how to address it. If needed, they may recommend an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol) for occasional headaches.

4. Cold and flu symptoms

Cold and flu symptoms can happen while you’re taking levetiracetam. Examples include a sore throat, runny or stuffy nose, and cough.

A cold usually goes away on its own. Your pharmacist can recommend OTC options to help manage your symptoms in the meantime. You can also try home remedies, such as gargling salt water. Try to stay hydrated and rest until you start feeling better.

If your cold symptoms are persistent or get worse, talk to your prescriber. Keep in mind that you could also have COVID, the flu, or a different type of infection. They can help figure out the cause and how to treat it. 

5. Dizziness

Levetiracetam may cause you to feel dizzy. To be safe, avoid performing tasks where dizziness can be dangerous until you know how levetiracetam affects you. And if you’re feeling dizzy, sit or lie down until you feel steady on your feet to avoid falling.

If you experience dizziness that isn’t going away or is getting worse, speak with your prescriber right away. There are several potential causes of dizziness. They can help you determine if it’s due to levetiracetam or something else.

6. Nausea

Some people may feel nauseous after taking levetiracetam. You can take levetiracetam with or without food. But if you experience nausea, taking your dose with a small snack or meal may help settle your stomach.

If nausea continues or if you start vomiting, contact your prescriber. And if you have severe vomiting, abdominal pain, or other concerning symptoms, go to the closest ER for further evaluation.  

7. Mood and behavioral changes

Mood and behavior changes, such as irritability and aggression, are possible with levetiracetam. During clinical trials, these side effects were reported by both adults and children taking levetiracetam. But they seemed to be reported more frequently in children.

Mood and behavior changes from levetiracetam can range from mild to severe. Examples may include:

• Depression

• Irritability

• Agitation

• Anger

• Nervousness

• Anxiety

• Aggression

• Suicidal thoughts

Don’t ignore these symptoms if they happen. Tell your prescriber right away if you notice any changes in mood or behavior. 

For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the 988 Suicide & Crisis Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line. 

8. Severe skin reactions

While rare, levetiracetam can cause serious skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. The FDA has also recently added Drug Reaction with Eosinophilia and Systemic Symptoms to the list of possible skin reactions with levetiracetam.

The risk of severe skin reactions is highest within the first couple weeks of starting levetiracetam, but these reactions can also occur months later. Symptoms can include flu-like symptoms (such as fever and sore throat), rash, and swollen lymph nodes. These symptoms can progress quickly and become life-threatening.

Go to the nearest ER if you develop a rash or any other unusual symptoms, such as unexplained swollen lymph nodes, after starting levetiracetam. While these symptoms could be from an infection or other cause, it’s better to be safe and seek care to be sure.

9. Blood disorders

Levetiracetam may cause a variety of potentially serious blood disorders due to its effects on certain blood cells. A few examples include: 

• Low red blood cell counts (anemia)

• Low platelets (thrombocytopenia)

• Low neutrophils (neutropenia)

These cells each play a specific role, such as causing your blood to clot, fighting infections, and carrying oxygen to tissues. If they’re lower than normal, you may experience side effects such as:

• Fatigue

• Shortness of breath

• Unusual bruising or bleeding

• Fever

• Diarrhea

• Sore throat

Your prescriber may monitor your blood work, which may include a complete blood count, while you take levetiracetam. Inform them right away if you experience any of these potential symptoms. 

When should you contact your prescriber about levetiracetam side effects?

If any levetiracetam side effects are concerning, persistent, or interfering with your daily activities, reach out to your prescriber. They can help determine the cause and discuss potential next steps. This may include trying different management strategies or adjusting your levetiracetam dose.

Certain levetiracetam side effects require emergency medical attention, including severe skin reactions. These types of reactions usually happen within a few weeks of starting the medication, but they can also happen later on. Watch for symptoms such as unexplained fever, swollen lymph nodes, or rash, and get emergency care if they develop.

Good to know: Certain medications may worsen levetiracetam side effects, such as those that also make you drowsy. Make sure your healthcare team has your current medication list to check for potential interactions in advance.

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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