An antiepileptic (seizure medicine)
Levetiracetam
A widely used, easy-to-start epilepsy medicine with few drug interactions — effective across many seizure types, though it can affect mood and behaviour in some people.
What is Levetiracetam?
Levetiracetam controls several types of epileptic seizure. It is popular because it can be started quickly, has very few interactions with other medicines, and does not need blood-level monitoring. Its main drawback is that in some people it affects mood or behaviour — causing irritability, low mood or agitation — which should be reported.
Education and reference only. This is a plain-language guide to Levetiracetam — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Levetiracetam is one of the most commonly prescribed modern antiepileptic medicines. It is used across a broad range of seizure types, in adults and children, on its own or alongside other treatments. Practically, it has several advantages: it can be started at an effective amount relatively quickly, it barely interacts with other medicines, and it does not require the blood-level monitoring some older antiepileptics need. It is taken as a tablet or liquid (with an injection used in hospital). Its main consideration is its occasional effect on mood and behaviour.
How it works
Levetiracetam works in a way that is different from most other antiepileptics: it binds to a protein in the nerve endings (SV2A) that is involved in releasing the brain’s chemical messengers. By modifying this release, it reduces the abnormal, excessive nerve signalling that produces seizures. Because it does not rely on the liver enzymes that many other drugs use, it has very few interactions.
What it treats
Conditions Levetiracetam is used for
Practical use
How to take Levetiracetam
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it twice a day as prescribed; it can be built up to an effective amount fairly quickly.
- Report any change in mood or behaviour — irritability, low mood, anxiety or agitation — as these can be eased by adjusting treatment.
- Do not stop suddenly; antiepileptics are reduced gradually to avoid seizures.
- It can be taken with or without food; use the liquid for children or those who cannot swallow tablets.
- No routine blood tests are needed, but keep up your epilepsy reviews.
Weighing it up
Advantages & disadvantages of Levetiracetam
Advantages
- Very few interactions with other medicines, and no routine blood-level monitoring.
- Can be started and brought to an effective amount quickly.
- Effective across many seizure types; considered one of the lower-risk antiepileptics in pregnancy.
Disadvantages
- Can cause mood and behaviour changes (irritability, low mood, agitation) in some people.
- Sometimes drowsiness or dizziness, especially early on.
- Taken twice daily.
Practical use
Good to know
Levetiracetam is generally straightforward to use — few interactions, no routine blood tests, and it can be brought up to an effective amount fairly quickly. The main thing to watch for is its effect on mood and behaviour: some people become irritable, low, anxious or agitated, and occasionally there are more significant mood changes. These are reversible on adjusting or changing the medicine, so report them rather than putting up with them. Vitamin B6 is sometimes used to help. As with any antiepileptic, do not stop it suddenly, and be aware of the general advice around antiepileptics in pregnancy (though levetiracetam is considered one of the lower-risk options).
Who should not take it / use with caution
- People who have reacted badly to it before.
- Used with care, at a reduced amount, in significant kidney impairment (it is cleared by the kidneys), and with attention in those with existing mental-health conditions.
- Pregnancy and breastfeeding are managed individually, under specialist guidance; do not stop suddenly.
Monitoring
- Seizure control
- Mood and behaviour
- Kidney function (guides the amount)
Side effects
- Common: drowsiness, tiredness, dizziness and headache, especially when starting.
- Mood and behaviour changes — irritability, low mood, anxiety, agitation — which should be reported.
- Sometimes cold-like symptoms; rarely, more significant mood disturbance or skin reactions.
Key interactions
- It has very few significant drug interactions, which is one of its main advantages.
- Other sedating medicines and alcohol can add to drowsiness.
- Its amount is reduced in kidney impairment because the kidneys clear it.
Available as: Tablets, an oral liquid (solution), and an injection used in hospital.
Answers
Levetiracetam: frequently asked questions
Can levetiracetam affect my mood?
Yes — in some people it causes irritability, low mood, anxiety or agitation, and occasionally more marked mood changes. These are reversible, so tell your prescriber rather than tolerating them; the amount can be adjusted, vitamin B6 sometimes helps, or an alternative can be chosen.
Why don’t I need blood tests on levetiracetam?
Unlike some older antiepileptics, levetiracetam has a wide safe range and very predictable handling, so routine blood-level monitoring is not needed. You should still attend your regular epilepsy reviews, and your kidney function may be checked as it guides the dose.
Does it interact with my other medicines?
Levetiracetam has very few interactions, which is one reason it is so widely used — it does not rely on the liver enzymes that cause many drug interactions. Even so, always tell your prescriber and pharmacist everything you take.
Is Keppra the same as levetiracetam?
Yes — levetiracetam is the generic (active-ingredient) name and Keppra is a brand name. For epilepsy, people are often kept on the same brand or version for consistency.
Authoritative sources
- BNF: Levetiracetam.
- electronic Medicines Compendium (SmPC): Levetiracetam (Keppra).
- NICE NG217: Epilepsies in children, young people and adults.
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