Neurology
Levetiracetam
An antiepileptic drug — A widely used, easy-to-start epilepsy drug — main watch-point is mood and behaviour.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Levetiracetam treats focal and generalised epilepsy and is often chosen for its ease of use and low interaction profile, in both regular and emergency (intravenous) settings.
How it works
It binds to a protein in the nerve-terminal machinery (SV2A) that helps regulate neurotransmitter release, calming the abnormal, excessive signalling that produces seizures. Its mechanism is distinct from older antiepileptics, which partly explains its clean interaction profile.
In practice
In practice levetiracetam has become a first-choice antiepileptic for many because it is straightforward to use: it can be started at an effective dose without slow titration, has few drug interactions, and does not need routine blood-level monitoring. Its dose is reduced as kidney function falls, since it is cleared renally. The characteristic side-effect to counsel and watch for is behavioural and psychological — irritability, low mood, anxiety or, less often, more significant mood disturbance — which can be dose-related and reversible; asking about mood at review is part of routine care. As with all antiepileptics it should not be stopped suddenly, and in epilepsy of childbearing age it is generally considered a safer option than valproate.
Examples
Practical use
How to take it & use it well
- Take levetiracetam regularly as prescribed, usually twice a day, with or without food.
- Do not stop suddenly if it is treating epilepsy, as this can bring on seizures; any change should be gradual and planned with your clinician.
- Be aware that it can affect mood and behaviour; tell someone you trust to look out for low mood, irritability or unusual aggression, and report these.
- If your kidney function is reduced, your dose may be lower, so keep to any monitoring your clinician arranges.
- Try not to miss doses; if you do, follow the advice on your information leaflet rather than doubling up.
Common uses
- Focal and generalised epilepsy
- Add-on or monotherapy
- Acute seizure management (intravenous)
Monitoring
- Seizure control
- Mood and behaviour
- Renal function for dose adjustment
Weighing it up
Advantages & disadvantages
Advantages
- Effective for several seizure types and often works well as an add-on or on its own.
- Few interactions with other medicines compared with many older epilepsy drugs.
- Does not usually require routine blood-level monitoring.
- Can be started relatively quickly compared with medicines that need slow titration.
Disadvantages
- Can cause mood and behaviour changes, including irritability, low mood, anxiety or, rarely, suicidal thoughts.
- Common side effects include drowsiness, dizziness and tiredness, especially at first.
- The dose needs adjusting if the kidneys are not working well.
- Some people notice headaches or cold-like symptoms.
Key safety principles
What to watch for
- Mood and behavioural effects — irritability, depression, anxiety or agitation; ask about these and review if they emerge.
- Reduce the dose in renal impairment (it is renally cleared).
- Do not stop abruptly; generally preferred over valproate in those who could become pregnant.
Key interactions
What to avoid or check alongside
- Other medicines that cause drowsiness (including alcohol and sedatives): can add to tiredness and reduced alertness.
- Other epilepsy medicines: usually compatible, but your clinician balances the overall combination.
- Medicines affecting the kidneys: because levetiracetam is cleared by the kidneys, dose review may be needed if kidney function changes.
- Medicines that lower mood or affect mental state: combined effects on mood and behaviour should be watched.
Patient & carer advice
- Tell us if you or those around you notice low mood, irritability or anxiety
- Do not stop it suddenly
- It generally has few interactions, but always check before adding new medicines
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Levetiracetam: frequently asked questions
Can levetiracetam affect my mood?
Yes, it can cause mood and behaviour changes such as irritability, low mood, anxiety, agitation or, rarely, thoughts of self-harm. Tell your clinician promptly if you or those around you notice these changes.
Why is my dose lower than someone else's?
Levetiracetam is removed by the kidneys, so people with reduced kidney function are usually given a lower dose to avoid build-up. Doses also vary by condition and individual response.
Do I need blood tests on levetiracetam?
Routine blood-level monitoring is not usually required. Your clinician may still check kidney function and review how you are getting on, particularly when starting or changing the dose.
Can I stop taking it if my seizures have settled?
Do not stop suddenly, as this can trigger seizures. If you and your clinician decide to reduce or stop it, this is done gradually under medical supervision.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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