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Keppra / Levetiracetam

Keppra (KEP-ruh) is the brand name used in the United States, Canada, the UK, Australia, and some other countries for the seizure medicine levetiracetam (lev-eh-teer-ASS-eh-tam).

250-mg (blue, oblong, scored)
Tablets marked with “ucb” and “250” on one side.

500-mg (yellow, oblong, scored)
Tablets marked with “ucb” and “500” on one side.

750-mg (orange, oblong, scored)
Tablets marked with “ucb” and “750” on one side.

1000-mg (white, oblong, scored)
Tablets marked with “ucb” and “1000” on one side

Liquid solution
100 mg/mL (clear, colorless, grape-flavored)
The liquid Keppra solution was approved by the FDA in 2003.

Liquid injection for intravenous administration
100 mg per 1 mL (milliliters). Approved by the FDA in 2006, this is an alternative for patients when oral administration is temporarily not feasible; it must be diluted prior to use as per the package insert and administered as a 15-minute intravenous infusion.

Keppra recently became available in generic (non-brand name) form as generic levetiracetam.

How to take and store Keppra
Follow your doctor's directions. Call if you have any questions. Usually, your doctor will tell you to start by taking one tablet—either 250 or 500 milligrams— two times each day. After a while, the doctor may gradually increase the dosage up to as much as 3000 milligrams per day to get better control of your seizures. To take that amount, you probably would take two 750-mg tablets, two times a day.

Most people swallow the tablets whole to avoid their bitter taste. But people who cannot swallow whole tablets can crush the tablet and mix it with food, or use the liquid form.

When measuring Keppra liquid, be sure to use a standard-size medicine spoon or dropper (not a regular teaspoon) to get the right amount every time.

It's OK to take Keppra either with food or without food, but it's a good idea to take it the same way every time. Taking Keppra with food does not change how much Keppra your body absorbs, but it does slow down the absorption a bit.

Be careful if the doctor writes a new prescription using a different kind of pill. For example, if you've been using 500-mg tablets and the new prescription is for 750-mg tablets, be sure you use the correct number. Don't automatically continue to use the same number of pills as before.

Don't take more than the doctor prescribes. If you think you've used one or two extra tablets or one extra spoonful of liquid, call your doctor for advice. For a larger overdose, call your local poison control center or emergency room right away, unless you have special instructions from the doctor.

Don't stop taking Keppra or change the amount you use without talking to the doctor first. Stopping any seizure medicine all at once can cause serious problems.

All forms of Keppra should be stored at room temperature, away from light and humidity. (Don't keep the pills in the bathroom if it's damp there.) Of course, keep all Keppra out of the reach of children.

What if I forget?
If you forget a dose of Keppra, take it as soon as you remember. If it is almost time for the next dose, delay that dose for a few hours, instead of taking two doses very close together. Then go back to the regular schedule. If you're not sure about what to do, call the doctor's office for more advice.

Do your best to follow the doctor's directions. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you.

Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!

Keppra is approved for three types of seizures:

Partial-onset seizures in patients 4 years or older. These are seizures that begin in a limited area of the brain. Sometimes these seizures spread throughout the brain (generalize).

Myoclonic seizures in patients aged 12 years or older with juvenile myoclonic epilepsy

Primary generalized tonic-clonic seizures in patients 6 years of age and older with idiopathic generalized epilepsy

Usually, Keppra is added when another seizure medicine is not controlling all seizures, rather than being used by itself.

Keppra is not metabolized by the liver. It also does not affect the way the liver metabolizes other medicines.

Instead, the body eliminates Keppra through the kidneys. People with poor kidney function usually need to take less Keppra and they may take it less often, because it stays in their body longer.

The tablets and the liquid form of Keppra take the same amount of time to be absorbed by the body. This time is a little longer if they are taken with food instead of on an empty stomach, but all the medicine is absorbed either way.

Doctors have studied large numbers of patients to find out how well Keppra controls seizures. In most of the studies, the Keppra was given to people who were taking another seizure medicine but still having seizures. With Keppra, between 20% and 40% of these people had the number of seizures cut at least in half. They also didn't have much trouble with side effects.

Keppra is not a perfect add-on seizure medicine for everyone, however. Sometimes people must try a series of combinations before finding what is best for them. But because Keppra doesn't interact with other medicines, it can be used as an add-on without the need for complicated changes in dosage.

At least one study has found that Keppra also may be effective when used alone to treat partial seizures.

Keppra has now been used by at least 100,000 people, and it appears to be very safe. In the earliest tests, people who took it as an add-on to another seizure medicine were only slightly more likely to quit because of side effects than people who took a placebo (a pill with no active medicine) instead.

Some side effects that have been reported include:

loss of strength and energy
other mood changes

Some of these are more likely during the first month of treatment.

If you notice any of these problems, call the doctor's office. Sometimes the doctor can help by changing the amount of Keppra you take or how you take it. Don't stop taking Keppra or change the amount you take without the doctor's guidance.

Some people have reported helpful effects from Keppra. They say they can think and concentrate better and feel more alert. It's hard to be sure whether these benefits are from the Keppra or from having fewer and less severe seizures.

If you have just started taking Keppra (or have just started taking a larger amount), be careful doing anything that might be dangerous until you know whether you are feeling sleepy, dizzy, or uncoordinated.

Allergic reactions
There are no known allergic reactions to Keppra.

Long-term side effects The long-term side effects of Keppra are not yet known.

Sometimes one kind of medicine changes the way another kind of medicine works in the body. Taking Keppra does not seem to cause this kind of problem. it does not affect the level of other medicines in the body, and other medicines do not affect the level of Keppra.

In children, Keppra has been used primarily to treat partial seizures, ones that begin in a limited area of the brain.

Doctors figure out how much medicine to give to young children based mostly on their weight. To keep side effects at a minimum, the doctor probably will prescribe a low dose to start with and increase it slowly. Children usually start with a dose of 10 milligrams (mg) for each kilogram (kg, about 2.2 pounds) of their body weight per day. This would be 250 mg per day for a 55-pound child, for instance. Half this amount is usually given two times a day.

After a gradual increase, most children do best taking about 20 to 40 mg per kg per day, Adjusted for weight, this is a little higher than the adult dose because children's bodies eliminate Keppra more quickly.

Talk to your doctor or another health professional if you are pregnant or plan to become pregnant. We don't yet have enough information to be able to estimate the risk of various types of birth defects that might occur if Keppra is taken during pregnancy. We also don't know enough to compare the risk with Keppra to the risk with other seizure medicines.

All women who are capable of becoming pregnant should take at least 0.4 mg (400 mcg) of the vitamin called folic acid every day because it helps to prevent one type of birth defect. (The most well-known of these is spina bifida, in which the spinal cord is not completely enclosed.) Women at high risk, such as those with a history of this kind of defect in a previous pregnancy, should take 4000 mcg (4 mg) daily, beginning before they become pregnant.

How much Keppra is passed through breast milk is not known for certain, but the way the body uses it suggests that probably a large portion does enter the milk. If you want to breast-feed your baby, check with your doctor about what seizure medicine would be best for you.