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Antiepileptic Pregnancy: Can be used during pregnancy only if considered clinically needed after careful assessment, at the lowest effective dose; avoid sudden discontinuation. Breast-feeding is not recommended (levetiracetam is excreted in human breast milk).

Levetiracetam

Brand names: Keppra, Desitrend

Used in: Head Injury Seizures & Epilepsy

Levetiracetam is a widely used antiepileptic for focal and generalised seizures, valued for few drug interactions and straightforward initiation.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 500 mg
Route: oral
Frequency: twice daily
Max: 1,500 mg twice daily (3,000 mg/day)
UK SPC, partial-onset seizures (monotherapy from 16 years and adjunctive therapy have the same dosing), for adults (>=18 years) and adolescents 12-17 years weighing >=50 kg. Initial therapeutic dose 500 mg twice daily, may be started on day 1; a lower start of 250 mg twice daily may be used and increased to 500 mg twice daily after two weeks. Titrate to clinical response up to a maximum of 1,500 mg twice daily, in 250 mg or 500 mg twice-daily increments/decrements every 2-4 weeks. Discontinue gradually (e.g. 500 mg twice-daily decreases every 2-4 weeks in adults/adolescents >50 kg). Adolescents 12-17 years weighing <50 kg and children from 1 month use weight-based dosing (select formulation, presentation and strength by weight, age and dose) - verify against a children's formulary; oral solution is preferred for young children and for doses under 250 mg.

Dose adjustments

Renal

Dose individualised to renal function (creatinine clearance). Adults/adolescents >50 kg: CLcr 50-79 ml/min/1.73m2 give 500-1,000 mg twice daily; 30-49 give 250-750 mg twice daily; <30 give 250-500 mg twice daily; ESRD on dialysis give 500-1,000 mg once daily with a 750 mg loading dose on day 1 and a 250-500 mg supplemental dose after dialysis. In severe hepatic impairment reduce the daily maintenance dose by 50% when CLcr <60 ml/min/1.73m2.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Use the oral solution for pediatric patients with body weight ≤ 20 kg ( 2.1 ) For pediatric patients, use weight-based dosing for the oral solution with a calibrated measuring device (not a household teaspoon or tablespoon) ( 2.1 ) Partial-Onset Seizures (monotherapy or adjunctive therapy) 1 Month to < 6 Months: 7 mg/kg twice daily; increase by 7 mg/kg twice daily every 2 weeks to recommended dose of 21 mg/kg twice daily ( 2.2 ) 6 Months to < 4 Years: 10 mg/kg twice daily; increase by 10 mg/kg twice daily every 2 weeks to recommended dose of 25 mg/kg twice daily ( 2.2 ) 4 Years to < 16 Years: 10 mg/kg twice daily; increase by 10 mg/kg twice daily every 2 weeks to recommended dose of 30 …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-11-21. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

  • Hypersensitivity to levetiracetam or other pyrrolidone derivatives, or to any of the excipients

Side effects

  • Nasopharyngitis
  • Somnolence
  • Headache
  • Fatigue
  • Dizziness

Clinical monograph

How it works

It binds synaptic vesicle protein SV2A, modulating neurotransmitter release — a mechanism distinct from older antiepileptics.

Prescribing in practice

  • Behavioural and mood effects are the main issue — irritability, agitation, depression and (rarely) suicidal thoughts.
  • Reduce the dose in renal impairment.
  • It has minimal enzyme interactions (useful in polypharmacy and in liver disease); do not stop it abruptly.

Monitoring

Review seizure control, mood/behaviour and renal function.

Counselling the patient

  • Report low mood, marked irritability or any thoughts of self-harm.
  • Do not stop it suddenly.

Evidence & guidelines

A first-line option for several seizure types (NICE NG217), favoured for its interaction profile.

Reference: NICE CG137; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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