Keppra (Levetiracetam)

Article Highlights

Keppra, approved for epilepsy and seizures, is a safe and well tolerated anticonvulsant with minimal interactions
Keppra has become the anticonvulsant of choice for elderly people with dementia who are at risk for seizures
Tablets that come from 250mg to 1000 mg can be taken with or without food
Keppra can induce aggression, depression, and suicidal thoughts

Levetiracetam (Brand name Keppra) was first developed as an epileptic drug for the treatment of convulsions, seizures, and epilepsy. Though relatively new on the antiepileptic scene, Levetiracetam has rapidly become a favorite medication for patients at risk for seizures. It has been approved for the treatment of both epilepsy and partial seizures in the United States, the European Union, and in many other countries around the world.

Elderly patients with dementia may be at risk of seizures; Levetiracetam (Keppra) has thus become many doctors’ first choice when prescribing an anticonvulsant drug. Levetiracetam has substantial benefits that can be of critical importance for elderly patients with Alzheimer’s or other types of dementia:

Benefits of Levetiracetam (Keppra)

Levetiracetam (Keppra) is safe
It has a quick onset or effect on elderly patients with dementia
It has no particularly worrisome side effects
Keppra has demonstrated that older age groups tolerate it well
It does not have significant interactions with other drugs
It is thought that Keppra does not add to deficits in cognition in patients with dementia who are already mentally impaired

KEPPRA (Levetiracetam) is an antiepileptic drug available as a blue tablet of 250 mg, a yellow tablet of 500 mg, an orange tablet of 750 mg, and a white tablet of 1,000. It also comes as a colorless, clear, grape-flavored liquid of 100 mg/mL for oral administration.

Keppra for the treatment of patients with dementia

Keppra (Levetiracetam) has been hailed as the anti-convulsing drug of first choice for elderly people with dementia who are at considerable risk for seizures. The problem has been that the traditional anticonvulsant drugs on the market are badly tolerated by aging patients with dementia until, that is, Keppra (Levetiracetam) was approved by the Food and Drug Administration (FDA) in 2008. Since then, it has been established that Keppra controls seizures effectively in patients of this age group.

Keppra and Dementia

As the elderly population with dementia is already cognitively impaired, the most appropriate anticonvulsant, safety and other health considerations apart, would be the one that does not further compromise their cognitive abilities. Keppra thus became an excellent anticonvulsant agent in elderly patients for a variety of reasons, including its efficacy, rapid onset of action, good side effect profile, and minimal health-impeding interactions with other medications.

Keppra and Mild Cognitive Impairment (MCI)

Keppra is a relatively novel approach for an existing condition, and is also thought to reverse a condition known as Mild Cognitive Impairment (MCI) in elderly patients who are at risk for dementia due to Alzheimer’s disease. Mild cognitive impairment is a clinically recognized condition in which impairment does not yet qualify as Alzheimer’s or another type of dementia while possibly being slightly more pronounced than in the normal aging process.

In addition to its’ treatment for patients with epilepsy, Keppra has been found to have a calming effect on the hyperactivity in the brain of persons with MCI. Not only is this type of hyperactivity well documented in persons with MCI, its occurrence moreover is a harbinger for further cognitive impairment of the type that can readily lead to Alzheimer’s disease or other types of dementia.

Keppra and Parkinson’s Disease

According to a study presented at the 56th annual meeting of the American Academy of Neurology, the antiepileptic drug levetiracetam (Keppra) reduced the involuntary movements (shaking and tremors) associated with the drug levodopa that is most used for the treatment of patients with Parkinson’s Disease.

The lead investigator in that study, Theresa Zesiewicz, M.D., assistant director of the Parkinson’s Disease and Movement Disorders Center, said that the drug levotopa offered significant challenges because of levotopa-induced Parkinson’s dyskinesia (stiffness, slow movements, shaking and tremors), and other side effects.

Keppra Dosage Information

Levetiracetam is used to treat partial onset seizures in adults and children who are at least 1 month old. Levetiracetam is also used to treat tonic-clonic seizures in adults and children who are at least 6 years old, and myoclonic seizures in adults and children who are at least 12 years old.

The dosage is based on your overall health condition and response to treatment. The dosage in children is also based on weight. To reduce your risk of side effects (such as dizziness and drowsiness), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Patients must use this medication regularly in order to get optimal benefit. To help you remember, take it at the same times each day.Take the liquid and regular-release tablets by mouth as directed by your doctor, usually twice daily with or without food. Crushing or chewing the tablet may cause a bitter taste. Furthermore, ask your pharmacist for a dose-measuring cup or spoon and always use that, instead of a regular table spoon, to measure medical liquid solutions.

If you are using the extended-release tablets, take this medication as directed by your doctor, usually once daily. Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Do not split tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

Dosage Forms & Strengths:

Tablet, immediate-release (Keppra, Generic)

250mg
500mg
750mg
1000mg

3-D tablet, immediate-release (Spritam)

250mg
500mg
750mg
1000mg

Tablet, extended-release (Keppra XR)

500mg
750mg

Oral solution (Keppra, Generic)

100mg/mL

Injectable solution

5mg/mL
10mg/mL
15mg/mL
100mg/mL

Levetiracetam (Keppra) Warnings and Side Effects

Behavioral side effects and general health warnings:

Alert your physician immediately if you experience any of the following unusual behavioral and other developments:

Sleep disturbances and sleeplessness
Agitation or restlessness
Aggression, anger, combativeness or violence
Feeling unduly depressed
Inability to concentrateo or focus, loss of appetite, and becoming apathetic or indifferent to activities that were of interest previously
Panic attacks
Acting out dangerous impulses
Having thoughts of suicide
Experiencing breathlessness, headaches, drowsiness, listlessness, feverishness, or any symptoms of infection
Problems with muscle control or coordination
Sensation of spinning

Other unusual signs and symptoms in your health

General Precautions

It is unwise to stop taking Keppra on your own without first consulting your physician. Doing so could lead to a continual chain of epileptic seizures. It is also unwise to deviate from your prescribed dose.
Give your physician a good recitation of your symptoms and medical history, so he or she can decide whether Keppra is a good medication for you, and what dose to prescribe.
It is also important that you tell your physician of any past moodiness or depression you may have experienced, for Keppra is known to induce depression and suicidal thoughts.
Tests have been conducted on persons 1 month and older, but it remains unknown if this drug is safe or effective in those younger than one month.

Known Major Side Effects of Keppra Include:

Increased blood pressure in those between one month and 4 years old, a serious health condition, is linked to the use of levetiracetam products.
People who use Keppra run the risk of becoming agitated, aggressive, angry, combative, stressed, depressed, or become indifferent and apathetic. They may additionally develop personality disorders such as depersonalization (a type of detachment within oneself in regard to body and mind).
Also reported among users of Levetiracetam (Keppra) are serious, though very infrequent side effects, dermatological reactions like: toxic epidermal necrolysis, a condition that can cause the skin to peel off in sheets, and Stevens-Johnson syndrome, a rare but severe skin condition.
Keppra has been known to cause suicidal thoughts/actions in a small number of people who are using it. You should contact your doctor immediately if you have thoughts of suicide or attempt to commit suicide, or if you experience new or worsening symptoms of depression, or other mental side effects of this nature.
If you are pregnant, it’s important your pregnancy and postpartum period be closely monitored by your physician, particularly if your dosage was changed while you were pregnant.
Although it is unknown if Keppra will be of harm for pregnant women, having a seizure during pregnancy nevertheless is serious; leave it to your physician to determine whether to keep you on the drug during the rest of your pregnancy, and do not breastfeed while on Keppra.

Signs of Trouble with a New Medication

Look out for any unusual and worrisome physical or behavioral changes you may experience, including skin conditions, swelling, trouble breathing, and other new conditions. If you are troubled and you cannot quickly reach your doctor, the best thing to do is to take your medication and go to the nearest ER and ask to be looked at for a possible new drug reaction or changed dose.

Drug interactions with Levetiracetam (Keppra)

Levetiracetam interacts with over 500 other drugs, although drugs that are commonly prescribed that have interactions with Keppra are few and include those in this short summary of classes of drugs:

antihistamines (such as cetirizine, doxylamine, and other)
antipsychotics (such as chlorpromazine, and other)
barbiturates (such as butalbital, pentobarbital phenobarbital)
benzodiazepines (such as alprazolam, diazepam, lorazepam)
muscle relaxants (such as cyclobenzaprine, methocarbamol and other)
narcotic pain relievers (such as codeine, morphine, and other)
selective serotonin reuptake inhibitors (SSRIs, such as citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
tricyclic antidepressants (such as amitriptyline, clomipramine, desipramine, trimipramine)
and a myriad of other drugs

Other Information About Keppra

Keppra and Drowsiness or Reduced Alertness

Patients who are pre-disposed to uncontrolled epileptic seizures should not drive or handle potentially dangerous machinery. Levetiracetam may cause drowsiness or problems with muscle control. If you are taking this medication, do not participate in activities requiring mental alertness or physical coordination until you have determined how this drug affects you.

Keppra and Anemia

Levetiracetam (Keppra) may cause low levels of red blood cells. If you experience symptoms of reduced red blood cell count (anemia) such as shortness of breath, feeling unusually tired or pale skin, contact your doctor as soon as possible.

Keppra and Hypersensitivity Syndrome

A severe allergic reaction called hypersensitivity syndrome has occurred with the use of this drug for some patients prone to epileptic seizures. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.

Keppra and Infection

Levetiracetam can reduce the number of cells that fight infection in the body (white blood cells). If you experience fever, sore throat, fatigue, weakness, or generally feel unwell while taking levetiracetam, contact your doctor as soon as possible. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Keppra and Kidney disease

Kidney disease or reduced kidney function may cause this medication to build up in the patient’s body, causing side effects. If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your overall health, how your medical condition may affect the dosing and effectiveness of this drug, and whether any special monitoring is needed. Patients with poor kidney function may need a lower dose of levetiracetam.

Alcohol and Antiepileptic Drugs

Alcoholic beverages and stimulant drugs like cocaine can increase your risk of having a seizure. Use alcohol with extreme moderation when taking an antiepileptic drug. Besides, these types of substances do harm to your brain cells, particularly in view of the epileptic condition you are in.

Antiepileptic Drugs and Suicide

Keppra and other antiepileptic drugs are thought to induce depression and thoughts of suicide, anxiety attacks, sleep disturbance, acting on risky (manic) impulses, restlessness, agitation, combativeness and aggression. If you are experiencing unusual depressive moods, thoughts of suicide, or these other symptoms, seek your doctor’s advice immediately.

Epilepsy Center

For immediate answers to all your questions on epileptic seizures, contact the Comprehensive Epilepsy Center in Charleston, SC, at (843) 792-3223.

Monitoring Keppra in Patients

Missing a Dose

If you miss a dose of your antiepileptic medicine, take it as soon as you realize that you missed it, unless this happens within 12 hours of your next dose, in which case you should skip it and make sure you take the next dose in timely fashion.

List of Medications

It’s always a good idea to take your antiepileptic medication bottle every time you go to see your doctor. If you are taking many meds, it’s a good idea to make a list of those, together with their doses and frequencies, to show to any doctors that you may visit. That way your doctor can confirm that your antiepileptic drug is not having adverse interactions with other meds.

Risks of Antiepileptic Drugs

All medications can have side effects, but many do not want to incur the risks of not taking their antiepileptic medication, which can include depression, poor focus, and possible physical injury from epileptic seizures. A good course of action is to let itself be guided by your physician who has probably treated many other patients with the same overall health conditions as you.

Signs of trouble with a New Medication

Consequences of Stopping Keppra

Don’t suddenly stop taking your antiepileptic medication, for you would be exposing yourself to severe seizures and other possible reactions. If you feel you want to stop taking your med, consult your doctor first.

Case story – Jim’s Grandmother

Jim’s grandmother was 73-years old and in relatively good health when one day she blacked out and fell to the floor. After collapsing, her heart stopped more than once in what was thought to have been “mini-strokes” or TIAs. The ambulance medics brought her back to life, and she was fitted with a pace maker at the hospital where she was taken.

The real problem however was that she fell on her head when she collapsed to the floor, and because she’d been on blood thinners, she had blood on her brain that caused first a seizure, and then a series of epileptic seizures. For her epileptic episodes, the doctors at the hospital gave her Keppra and kept her under close supervision for the week that followed.

Another 10 days ensues at the rehab center, Jim noticed that she was fast declining in more than one way. She lost her appetite, seemed indifferent to her surroundings, and she wanted to sleep most of the time. The last thing she wanted to do also was the physical therapy that her primary care physician had prescribed for her in his Plan of Care. She had turned completely apathetic -and distant, as though she was observing herself from a distance.

When Jim got anxious about her decline, he alerted her physician ho in turn alerted the neurologist who’d been part of the medical team who’d taken care of her at the hospital. The first thing the neurologist did was lower he dose of Keppra. From the 1000mg a day she’d been taking (plus an added 500mg three days a week, the neurologist reduced all that to 500 mg a day, which seemed to have a reversing effect on her and seemed to settle her down.

The neurologist was apologetic and explained to Jim that because of the traumatic brain injury she had sustained when she fell, and because of her age and probable onset of mild cognitive impairment (MCI), it was going to be impossible to predict if she would have further seizures or not. He told Jim that his primary concern, beyond the seizures, was that she would develop full-blown MCI that might lead to Alzheimer’s.