Levetiracetam

Levetiracetam can be taken by adults and children aged one month and over. However, Levetiracetam is not suitable for some people. To make sure Levetiracetam is safe for you, tell your doctor if you:

• have ever had an allergic reaction to Levetiracetam or other medicines in the past
• have kidney problems
• have had a low mood (depression) or thoughts of harming or killing yourself in the past
• are pregnant, or planning to become pregnant
• have an intolerance to some sugars – some brands of Levetiracetam liquid contain maltitol
• have ever had an allergic reaction to preservatives and artificial food colourings like sunset yellow (E110). Some brands of Levetiracetam contain these

Pregnancy and breastfeeding

Levetiracetam and Pregnancy

There is no firm evidence that Levetiracetam is harmful to an unborn baby, but for safety, your doctor will only advise you to take it in pregnancy if the benefits of the medicine outweigh the risks.

If you become pregnant while taking Levetiracetam, tell your doctor or nurse straight away. Do not stop the medicine without talking to your doctor first. If you are pregnant or trying to get pregnant, and taking Levetiracetam, you are recommended to take a higher dose of folic acid- a vitamin that helps your baby grow normally.

Your doctor might prescribe a high dose of 5mg a day for you to take when you are trying to get pregnant and also during the first 12 weeks of pregnancy.

Levetiracetam and breastfeeding

Levetiracetam passes into breast milk in small amounts. If your doctor says your baby is healthy, Levetiracetam can be taken while you are breastfeeding. 

There have been some reports of side effects in breastfed babies, including not feeding well, but in most cases, babies do not get any side effects.

If your baby is not feeding as well as usual, seems unusually sleepy, or you have any other concerns about them, talk to your pharmacist, health visitor or doctor as soon as possible.

Levetiracetam is a prescription medicine. It is important to take it as advised by your doctor.

Dosage

The usual dose of Levetiracetam to treat epilepsy in:

• Adults and older children (aged 12 years and over) – 250mg to 3,000mg a day, taken as 1 or 2 doses, but the exact dose may depend on your weight.

• Children (aged 1 month to 12 years) – Varies depending on their weight

How to take it

You can take Levetiracetam with or without food.

If you take it twice a day, try to space your doses evenly through the day – for example, first thing in the morning and in the evening.

Tablets – Swallow whole with a drink of water, milk or juice. Do not chew them.

Liquid – Can be swallowed whole or mixed into a glass of water, milk or juice. This comes with a syringe to help you measure it. If you do not have a syringe, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give you the right amount.

Granules – Can be swallowed straight from the packet or mixed with food or water. Do not chew them. Drink some water after you have swallowed them.

Will my dose go up or down?

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few weeks.

Once you find a dose that suits you, it will usually stay the same.

What if I forget to take it?

If you take Levetiracetam and miss a dose:

• once a day – take the missed dose as soon as you remember. If it is less than 12 hours before the next dose is due, leave out the missed dose and take your next dose as normal.

• twice a day – take the missed dose as soon as you remember. If it is less than 8 hours before the next dose is due, leave out the missed dose and take your next dose as normal.

Do not take 2 doses at the same time or take an extra dose to make up for a forgotten one. It is important to take this medicine regularly. Missing doses may trigger a seizure. If you forget doses often, it may help to set an alarm to remind you.

What if I take too much?

Taking too much Levetiracetam can cause serious side effects.

You take too much Levetiracetam and:

• feel sleepy or less alert
• feel agitated or aggressive
• have problems breathing
• pass out

Like all medicines, Levetiracetam can cause side effects, although not everyone gets them.

Common side effects

These common side effects may happen in more than 1 in 100 people. They are usually mild and go away by themselves.

Keep taking the medicine, but talk to your pharmacist or doctor if these side effects bother you or do not go away.

Some common side effects include;

• a blocked nose or itchy throat
• feeling drowsy, sleepy or dizzy
• headaches
• aggression, or feeling irritable or agitated
• feeling or being sick (nausea or vomiting)

Serious side effects

Very few people taking Levetiracetam have serious problems. Tell a doctor straight away if you have a serious side effect, including:

• Flu-like symptoms and a rash on the face, or a rash that spreads or forms blisters – these can be signs of a rare serious skin condition called Stevens-Johnson syndrome
• Seizures getting worse
• Passing very little pee, feeling tired or confused, or having swollen legs, ankles or feet – these could be signs of kidney problems
• Signs of serious mental changes, or someone around you notices signs of confusion, sleepiness, loss of memory, forgetfulness, abnormal behaviour or uncontrolled movements
• Thoughts of harming or killing yourself – a small number of people taking Levetiracetam have had suicidal thoughts

Serious allergic reaction

In rare cases, it is possible to have a serious allergic reaction (anaphylaxis) to Levetiracetam including;

• Skin rash that may include itchy, red, swollen, blistered or peeling skin
• Wheezing
• Tightness in the chest or throat
• Trouble breathing or talking
• Swelling in the mouth, face, lips, tongue or throat 

How to cope with side effects of Levetiracetam

What to do about:

• A blocked nose or itchy throat – if it is bothering you, ask your pharmacist for something to help your symptoms. If they do not wear off, inform your doctor

• Feeling drowsy, sleepy or dizzy – as your body gets used to Levetiracetam, these side effects should wear off. Do not drive, ride a bike, or operate machinery until you feel more alert. If they do not wear off within 1 or 2 weeks, your doctor may reduce your dose or increase it more slowly. If that does not work, you may need to switch to a different medicine

• Headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. If it is a problem, ask your pharmacist to recommend a painkiller. Talk to your doctor if your headaches last longer than a week or are severe.
• Aggression, or feeling irritable or agitated – talk to your doctor if you have any of these side effects.
• Feeling or being sick – stick to simple meals and do not eat rich or spicy food. It might help to take your levetiracetam after a meal or snack. If you’re being sick, take small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any medicines to treat vomiting without speaking to a pharmacist or doctor. 

Cautions with other medicines

Some medicines and Levetiracetam interfere with each other and increase your side effects.

There might be a problem taking some herbal remedies and supplements alongside Levetiracetam, especially ones that cause sleepiness or dizziness.

How does Levetiracetam work?

Brain cells normally “talk” to each other using electrical signals and chemicals. Seizures can happen when the brain cells are not working properly or working faster than usual. 

Levetiracetam slows down these electrical signals to stop seizures. Levetiracetam also works differently from most epilepsy medicines.

How long does it take to work?

It usually takes a few weeks for Levetiracetam to work properly. This is because the dose of levetiracetam needs to be increased slowly. You may still have seizures during this time

Are there similar medicines?

Brivaracetam is very similar to Levetiracetam. They work in the same way, but these medicines are given at different doses. If you decide to try Brivaracetam instead, your doctor will explain how to come off Levetiracetam safely.

Is it safe to take Levetiracetam for a long time?

Levetiracetam is a relatively new medicine. At the moment, there is no evidence to show it has lasting harmful effects if you take it for many months or years.

How does it compare with other medicines?

Other medicines to treat epilepsy include Brivaracetam, Arbamazepine, Clobazam, Ethosuximide, Gabapentin, Lamotrigine, Phenytoin, Pregabalin, Sodium Valproate and Topiramate.

Can I switch to a different medicine?

If you are switching medicines, it is very important to do it exactly as your doctor tells you to. If you want to switch, you will usually start taking the new medicine at a low dose and slowly build up the dose while you are still taking Levetiracetam. It is not always important to stay on the same brand, but ask your doctor.

Can I come off Levetiracetam?

If you are taking Levetiracetam for epilepsy, stopping it suddenly can cause seizures. Coming off Levetiracetam should be done very slowly and might take a few months. If you get a serious side effect, such as a severe skin condition, your doctor may tell you to stop taking Levetiracetam straight away, even if you have epilepsy.

What is ‘Keppra rage’ and how may this affect my mood?

Keppra is a brand of Levetiracetam. Levetiracetam can sometimes cause changes in your mood or behaviour. You may feel angry, agitated or depressed.

This side effect does not affect everyone, but it is important to tell your doctor if you have any changes in your mood, feel depressed or have thoughts of harming yourself.

Do I need to take vitamin B alongside my Levetiracetam?

Some people take vitamin B6 (also known as pyridoxine) alongside Levetiracetam to reduce the chances of mood changes.

A few studies have reported that vitamin B6 might be helpful, but we do not have enough information to be sure. If you wish to take any vitamins alongside your prescribed medicines, it’s important to speak to your pharmacist or doctor, who can advise you what you can take.

Will it affect my contraception?

Levetiracetam does not affect any type of contraception, including the combined pill and emergency contraception.

Will it affect my fertility?

It is not thought that levetiracetam affects female fertility.

Some men with epilepsy or on epilepsy medication may have reduced levels of testosterone. Some epilepsy medicines also reduce the amount of sperm you produce or affect the quality of it.

This does not affect everyone, but could make you less fertile. Talk to your doctor if you have any concerns.

Does Levetiracetam cause weight loss?

Levetiracetam does not usually affect weight at all.

Can I drink alcohol with it?

Yes, you can drink alcohol with Levetiracetam, but it may make you feel sleepy or tired, and alcohol and hangovers can bring on seizures in some people with epilepsy.

During the first few days of taking Levetiracetam, it is best to stop drinking alcohol until you see how the medicine affects you. If you do drink, try not to have more than the recommended guidelines of up to 14 units of alcohol a week.

Is there any food or drink I need to avoid?

No, you can eat and drink normally while taking Levetiracetam.

Can I drive or ride a bike with it?

You may feel sleepy, tired or dizzy when you first start taking Levetiracetam or when the dose is increased. If this happens to you, do not drive or ride a bike or operate machinery until you feel more alert. It can also affect your vision. Do not drive if your vision is affected.