Levetiracetam (Keppra)

Primer

Levetiracetam (Trade name: Keppra) is an anticonvulsant medication used in the treatment of seizures. There is also preliminary evidence for its use in psychiatric disorders such as anxiety and mood disorders. It is also known to cause neuropsychiatric side effects.

Pharmacokinetics

Pharmacokinetics of Levetiracetam

Absorption
Distribution
Metabolism
Elimination
Half-life

Levetiracetam: Cytochrome P450 Metabolism

Substrate of (Metabolized by)
Induces
Inhibits

Pharmacodynamics

Mechanism of Action

  • SV2A receptor blocker
  • Modulates GABA and glutamate release
  • Inhibits voltage-gated Ca2+ channels

Toxicity

Indications

Dosing

Dosing for Levetiracetam

Starting
Titration
Maximum
Taper

Formulations

  • Levetiracetam comes in

Monitoring

Contraindications

Absolute

Relative

Drug-Drug Interactions

Side Effects

  • Fatigue, drowsiness, and headaches

Adverse Events

  • Neuropsychiatric symptoms including anxiety, agitation, personality changes, and psychosis.[1][2][3]

Clinical Pearls

Special Populations

Geriatric

Pediatric

Obstetric and Fetal

Medically Ill

Resources

References

1) Dannaram, S., Borra, D., Pulluri, M., Jindal, P., & Sharma, A. (2012). Levetiracetam-induced acute psychotic episode. Innovations in clinical neuroscience, 9(10), 10.
2) Josephson, C. B., Engbers, J. D., Jette, N., Patten, S. B., Singh, S., Sajobi, T. T., ... & Wiebe, S. (2019). Prediction tools for psychiatric adverse effects after levetiracetam prescription. JAMA neurology, 76(4), 440-446.
3) Kathiravan, M., Dhawan, S. R., Singanamala, B., Saini, L., & Sahu, J. K. (2019). Levetiracetam Induced Neuropsychiatric Manifestation in a 5-year-old Boy. The Indian Journal of Pediatrics, 86(2), 193-193.