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Antiepileptic — Second-Line Status Epilepticus

Levetiracetam IV (Status Epilepticus)

Brand names: Keppra IV

This is intravenous levetiracetam used as a second-line agent in established convulsive status epilepticus (after first-line benzodiazepines), given as a short infusion.

Dosing — not shown for this use

The product information we hold does not support a dose for this page's specific use, route or population, so none is shown. Follow your local or national guideline, and confirm against the product SmPC.

Clinical monograph

How it works

Levetiracetam binds the synaptic vesicle protein SV2A, modulating neurotransmitter release to reduce seizure activity — a mechanism distinct from sodium-channel and GABAergic antiepileptics.

Prescribing in practice

  • It is favoured in status epilepticus because it needs no cardiac or blood-pressure monitoring and has few interactions (unlike phenytoin) — but reduce the dose in renal impairment.
  • It is one of several comparable second-line options (with phenytoin/fosphenytoin and sodium valproate); the choice depends on patient factors and local protocol.
  • Behavioural and mood effects (agitation, irritability, low mood) can occur, particularly with continued oral use.

Monitoring

Monitor seizure response and conscious level acutely; with ongoing treatment review renal function and mood/behaviour.

Counselling the patient

  • It is given by infusion in hospital to stop a prolonged seizure; treatment is usually switched to tablets once the patient is stable.
  • Report low mood or marked irritability when it is continued as regular treatment.

Evidence & guidelines

Comparable to phenytoin and valproate as second-line therapy in established status epilepticus (ESETT in adults; EcLiPSE/ConSEPT in children; NICE NG217).

Reference: STELUS Trial; ESETT Trial (NEJM 2019); NICE NG217; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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