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 many individuals, including older adults with dementia, who are at risk for seizures.
- Tablets that come from 250 mg to 1000 mg can be taken with or without food.
- Negative side effects of Keppra can include aggression, depression, and suicidal thoughts.
Overview
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.
Older adults 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 individuals with Alzheimer’s or other types of dementia:
Benefits of Levetiracetam (Keppra)
- Levetiracetam (Keppra) is safe.
- It has a quick onset or effect on older adults 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 individuals with dementia.
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 Persons with Dementia
Keppra (Levetiracetam) has been hailed as the anti-convulsing drug of first choice for older adults 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 individuals 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 people of this age group.
Keppra and Dementia
As the older population with dementia is already experiencing cognitive impairment, the most appropriate anticonvulsant, safety and other health considerations apart, is one that does not further compromise their cognitive abilities. Keppra thus became an excellent anticonvulsant agent for use in older individuals 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 older adults 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 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 individuals 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 adverse 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 benefits. To help you remember, you should 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 concentrate or focus, loss of appetite, and indifference to activities that were of interest previously
- Panic attacks
- Acting out dangerous impulses
- 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 old.
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 that 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.
Drug Interactions with Levetiracetam (Keppra)
Levetiracetam can interact with over 500 other drugs, although drugs that are commonly prescribed that have interactions with Keppra are few and include those in the below summary of drug classes:
- 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 them, 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 will not have adverse interactions with other medications.
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 be guided by your physician, who can help you weigh the costs and benefits.
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.
Consequences of Stopping Keppra
Don’t suddenly stop taking your antiepileptic medication, for you would be exposing yourself to the risk of severe seizures and other possible reactions. If you feel you want to stop taking the medication, 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 in 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 ensued at the rehab center, and Jim noticed that she was 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 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 who 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 her dose of Keppra. From the 1000 mg a day she’d been taking (plus an added 500 mg three days a week), the neurologist reduced the dose to 500 mg a day, which seemed to reverse the negative effects and 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.
Final Thoughts
Levetiracetam (Keppra) is a drug used for the treatment of convulsions, seizures, and epilepsy. Though relatively new on the market, Levetiracetam has quickly become a common treatment for individuals at risk of seizures. As with any medication, there are potential risks and side effects, so you should consult with medical professionals to determine if Keppra can be helpful for you.