levetiracetam (Rx)

Brand and Other Names:Keppra, Keppra XR, more...Spritam, Elepsia XR

Dosing & Uses

AdultPediatric

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

  • 500mg (Keppra XR)
  • 750mg (Keppra XR)
  • 1000mg (Elepsia XR)
  • 1500mg (Elepsia XR)

oral solution (Keppra, generic)

  • 100mg/mL

injectable solution

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

Myoclonic Seizures

Immediate-release (Keppra, Spritam): 500 mg IV/PO q12hr; may increase q2week by 500 mg/dose to recommended dose of 1500 mg q12hr

Effectiveness of doses >3000 mg/day has not been adequately studied

Partial Onset Seizure

Indicated for treatment of partial-onset seizures

Need for oral loading dose not established

Immediate-release (Keppra, Spritam): 500 mg PO q12hr; may increase q2week by 500 mg/dose; not to exceed 3000 mg/day

Extended-release (Keppra XR or Elepsia XR): 1000 mg PO qDay; may increase q2week by 1000 mg/day; not to exceed 3000 mg/day

IV: 500 mg q12hr; may increase q2week by 500 mg/dose; not to exceed 3000 mg/day

Primary Generalized Tonic-Clonic Seizures

Need for oral loading dose not established

Immediate-release (Keppra, Spritam): 500 mg IV/PO q12hr; may increase q2week by 500 mg/dose to recommended dose of 1500 mg q12hr

Effectiveness of doses >3000 mg/day has not been adequately studied

Dosage Modifications

Renal impairment

  • Immediate release and IV formulations
    • CrCl >80 mL/min/1.73 m²: Dose adjustment not required
    • CrCl 50-80 mL/min/1.73 m²: 500-1000 mg PO q12hr
    • CrCl 30-50 mL/min/1.73 m²: 250-750 mg PO q12hr
    • CrCl <30 mL/min/1.73 m²: 250-500 mg PO q12hr
    • Dialysis (conventional): 500-1000 mg PO qDay, THEN 250-500 mg supplemental dose after dialysis
  • Extended release tablets (Keppra XR)
    • CrCl >80 mL/min/1.73 m²: Dose adjustment not required
    • CrCl 50-80 mL/min/1.73 m²: 1000-2000 mg PO q24hr
    • CrCl 30-50 mL/min/1.73 m²: 500-1500 mg PO q24hr
    • CrCl <30 mL/min/1.73 m²: 500-1000 mg PO q24hr
    • End-stage renal disease requiring hemodialysis: Immediate release formulation recommended
  • Extended release tablets (Elepsia XR)
    • CrCl >80 mL/min/1.73 m²: Dose adjustment not required
    • CrCl 50-80 mL/min/1.73 m²: 1000-2000 mg PO q24hr
    • CrCl <50 mL/min/1.73 m²: Not recommended
    • End-stage renal disease requiring hemodialysis: Immediate release formulation recommended

Dosing Considerations

Avoid abrupt withdrawal to reduce the risk of increased seizure frequency and status epilepticus

Dosage Forms & Strengths

tablet, immediate-release (Keppra, generic)

  • 250mg
  • 500mg
  • 750mg
  • 1000mg

disintegrating tablet, immediate-release (Spritam)

  • 250mg
  • 500mg
  • 750mg
  • 1000mg

tablet, extended-release

  • 500mg (Keppra XR)
  • 750mg (Keppra XR)
  • 1000mg (Elepsia XR)
  • 1500mg (Elepsia XR)

oral solution (Keppra, generic)

  • 100mg/mL

injectable solution

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

Partial Onset Seizures

Immediate-release tablets (Keppra)

  • Indicated for monotherapy or adjunctive treatment of partial-onset seizures in patients aged ≥1 month
  • <1 month: Safety and efficacy not established
  • 1-6 months: 7 mg/kg PO q12hr; increase by increments of 7 mg/kg q12hr q2weeks to recommended dose of 21 mg/kg q12hr  
  • 6 months-4 years: 10 mg/kg PO q12hr, increase in increments of 10 mg/kg q12hr q2weeks to recommended dose of 25 mg/kg q12hr
  • 4-16 years: 10 mg/kg PO q12hr; increase q2week by 10 mg/kg/dose to 30 mg/kg q12hr
  • >16 years: 500 mg PO q12hr, increase by 500 mg q12hr q2weeks to recommended dose of 1500 mg q12hr

Immediate-release 3-D tablets (Spritam)

  • Indicated for treatment of partial-onset seizures in patients aged >4 years
  • <4 years: Safety and efficacy not established
  • ≥4 years weighing 20-40 kg: 250 mg PO BID initially; increase daily dose q2wk by increments of 500 mg (250 mg BID) to a maximum daily dose of 1500 mg (750 mg BID)
  • ≥4 years weighing >40 kg: 500 mg PO BID initially; increase daily dose q2wk by increments of 1000 mg (500 mg BID) to a maximum daily dose of 3000 mg (1500 mg BID)

Extended-release tablets (Keppra XR or Elepsia XR)

  • Indicated as adjunctive therapy for treatment of partial-onset seizures in patients ≥12 years
  • <12 years: Safety and efficacy not established
  • &12 years: 1000 mg PO qDay initially; may adjust dose by 1000 mg increments q2wk to a maximum of 3000 mg/day

Primary Generalized Tonic-Clonic Seizures

<6 years: Safety and efficacy not established

Keppra

  • 6-16 years: 10 mg/kg PO q12hr; increase q2week by 10 mg/kg/dose to recommended dose of 30 mg/kg q12hr; efficacy of doses <60 mg/kg/day not established  
  • >16 years: 500 mg PO q12hr, increase by 500 mg q12hr q2weeks to recommended dose of 1500 mg q12hr

Spritam

  • ≥6 years weighing 20-40 kg: 250 mg PO BID initially; increase the daily dose q2wk by increments of 500 mg (250 mg BID) to a maximum recommended daily dose of 1500 mg/day (750 mg BID) ≥6 years weighing
  • >40 kg: 500 mg PO BID initially; increase the daily dose q2wk by increments of 1000 mg (500 mg BID) to a maximum recommended daily dose of 3000 mg (1500 BID)
  • Effectiveness of doses >3000 mg/day has not been adequately studied

Myoclonic Seizures

Keppra, Spritam

<12 years: Safety and efficacy not established

≥12 years: 500 mg PO q12hr; increase by 500 mg q12hr q2week to recommended dose of 1500 mg q12hr

Effectiveness of doses >3000 mg/day has not been studied

Neonatal Seizures (Orphan)

Orphan indication sponsor

  • University of California; UCSD Medical Center 0935; La Jolla, CA 92093-0935

Dosing Considerations

Avoid abrupt withdrawal to reduce the risk of increased seizure frequency and status epilepticus

Next:

Interactions

Interaction Checker

and levetiracetam

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            All Interactions Sort By:
             activity indicator 

            Contraindicated (1)

            • thalidomide

              levetiracetam and thalidomide both increase sedation. Contraindicated.

            Serious - Use Alternative (18)

            • alfentanil

              levetiracetam and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • buprenorphine

              levetiracetam and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • buprenorphine buccal

              levetiracetam and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • codeine

              levetiracetam and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • deferiprone

              deferiprone, levetiracetam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.

            • hydrocodone

              levetiracetam and hydrocodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • hydromorphone

              levetiracetam and hydromorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • methadone

              levetiracetam and methadone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • methohexital

              levetiracetam and methohexital both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • metoclopramide intranasal

              levetiracetam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • morphine

              levetiracetam and morphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • oxycodone

              levetiracetam and oxycodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • oxymorphone

              levetiracetam and oxymorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • pentobarbital

              levetiracetam and pentobarbital both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • phenobarbital

              levetiracetam and phenobarbital both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

            • ropeginterferon alfa 2b

              ropeginterferon alfa 2b, levetiracetam. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.

            • tramadol

              levetiracetam and tramadol both increase sedation. Avoid or Use Alternate Drug.

            • triazolam

              levetiracetam and triazolam both increase sedation. Avoid or Use Alternate Drug.

            Monitor Closely (175)

            • acalabrutinib

              acalabrutinib, levetiracetam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.

            • acetaminophen/phenyltoloxamine

              levetiracetam and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.

            • acrivastine

              acrivastine and levetiracetam both increase sedation. Use Caution/Monitor.

            • alprazolam

              levetiracetam and alprazolam both increase sedation. Use Caution/Monitor. Limit use to patients for whom alternative treatment options are inadequate

            • amisulpride

              amisulpride and levetiracetam both increase sedation. Use Caution/Monitor.

            • amitriptyline

              levetiracetam and amitriptyline both increase sedation. Use Caution/Monitor. Limit use to patients for whom alternative treatment options are inadequate

            • amobarbital

              levetiracetam and amobarbital both increase sedation. Use Caution/Monitor. Limit use to patients for whom alternative treatment options are inadequate

            • amoxapine

              levetiracetam and amoxapine both increase sedation. Use Caution/Monitor.

            • aripiprazole

              levetiracetam and aripiprazole both increase sedation. Use Caution/Monitor.

            • asenapine

              asenapine and levetiracetam both increase sedation. Use Caution/Monitor.

            • asenapine transdermal

              asenapine transdermal and levetiracetam both increase sedation. Use Caution/Monitor.

            • avapritinib

              avapritinib and levetiracetam both increase sedation. Use Caution/Monitor.

            • baclofen

              levetiracetam and baclofen both increase sedation. Use Caution/Monitor. Limit use to patients for whom alternative treatment options are inadequate

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen and levetiracetam both increase sedation. Use Caution/Monitor.

            • betrixaban

              levetiracetam will decrease the level or effect of betrixaban by unknown mechanism. Use Caution/Monitor.

            • brexanolone

              brexanolone, levetiracetam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brexpiprazole

              brexpiprazole and levetiracetam both increase sedation. Use Caution/Monitor.

            • brimonidine

              brimonidine and levetiracetam both increase sedation. Use Caution/Monitor.

            • brivaracetam

              brivaracetam, levetiracetam. Other (see comment). Use Caution/Monitor. Comment: Coadministration provided no added therapeutic benefit and may cause additive/synergistic adverse effects.

              brivaracetam and levetiracetam both increase sedation. Use Caution/Monitor.

            • brompheniramine

              levetiracetam and brompheniramine both increase sedation. Use Caution/Monitor.

            • buprenorphine subdermal implant

              buprenorphine subdermal implant and levetiracetam both increase sedation. Use Caution/Monitor.

            • buprenorphine transdermal

              buprenorphine transdermal and levetiracetam both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              buprenorphine, long-acting injection and levetiracetam both increase sedation. Use Caution/Monitor.

            • butabarbital

              levetiracetam and butabarbital both increase sedation. Use Caution/Monitor.

            • butalbital

              levetiracetam and butalbital both increase sedation. Use Caution/Monitor.

            • butorphanol

              levetiracetam and butorphanol both increase sedation. Use Caution/Monitor.

            • carbinoxamine

              levetiracetam and carbinoxamine both increase sedation. Use Caution/Monitor.

            • cariprazine

              cariprazine and levetiracetam both increase sedation. Use Caution/Monitor.

            • carisoprodol

              levetiracetam and carisoprodol both increase sedation. Use Caution/Monitor.

            • cenobamate

              levetiracetam and cenobamate both increase sedation. Use Caution/Monitor.

            • cetirizine

              levetiracetam and cetirizine both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              levetiracetam and chlordiazepoxide both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              levetiracetam and chlorpheniramine both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              levetiracetam and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              levetiracetam and chlorzoxazone both increase sedation. Use Caution/Monitor.

            • clemastine

              levetiracetam and clemastine both increase sedation. Use Caution/Monitor.

            • clobazam

              levetiracetam and clobazam both increase sedation. Use Caution/Monitor.

            • clomipramine

              levetiracetam and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              levetiracetam and clonazepam both increase sedation. Use Caution/Monitor.

            • clonidine

              levetiracetam and clonidine both increase sedation. Use Caution/Monitor.

            • clorazepate

              levetiracetam and clorazepate both increase sedation. Use Caution/Monitor.

            • clozapine

              levetiracetam and clozapine both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              levetiracetam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              levetiracetam and cyproheptadine both increase sedation. Use Caution/Monitor.

            • dabigatran

              levetiracetam will decrease the level or effect of dabigatran by unknown mechanism. Use Caution/Monitor.

            • dantrolene

              levetiracetam and dantrolene both increase sedation. Use Caution/Monitor.

            • daridorexant

              levetiracetam and daridorexant both increase sedation. Use Caution/Monitor.

            • desflurane

              levetiracetam and desflurane both increase sedation. Use Caution/Monitor.

            • desipramine

              levetiracetam and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              levetiracetam and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexbrompheniramine

              levetiracetam and dexbrompheniramine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              levetiracetam and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

            • diazepam

              levetiracetam and diazepam both increase sedation. Use Caution/Monitor.

            • difenoxin hcl

              levetiracetam and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              levetiracetam and dimenhydrinate both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              levetiracetam and diphenhydramine both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              levetiracetam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • doxepin

              levetiracetam and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              levetiracetam and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              levetiracetam and droperidol both increase sedation. Use Caution/Monitor.

            • edoxaban

              levetiracetam will decrease the level or effect of edoxaban by unknown mechanism. Use Caution/Monitor.

            • efavirenz

              levetiracetam and efavirenz both increase sedation. Use Caution/Monitor.

            • entacapone

              levetiracetam and entacapone both increase sedation. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, levetiracetam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • estazolam

              levetiracetam and estazolam both increase sedation. Use Caution/Monitor.

            • eszopiclone

              levetiracetam and eszopiclone both increase sedation. Use Caution/Monitor.

            • ethanol

              levetiracetam and ethanol both increase sedation. Use Caution/Monitor.

            • ethosuximide

              levetiracetam and ethosuximide both increase sedation. Use Caution/Monitor.

            • ethotoin

              levetiracetam and ethotoin both increase sedation. Use Caution/Monitor.

            • felbamate

              levetiracetam and felbamate both increase sedation. Use Caution/Monitor.

            • fenfluramine

              levetiracetam and fenfluramine both increase sedation. Use Caution/Monitor.

            • fentanyl

              fentanyl and levetiracetam both increase sedation. Use Caution/Monitor.

            • fentanyl intranasal

              fentanyl intranasal and levetiracetam both increase sedation. Use Caution/Monitor.

            • fentanyl iontophoretic transdermal system

              fentanyl iontophoretic transdermal system and levetiracetam both increase sedation. Use Caution/Monitor.

            • fentanyl transdermal

              fentanyl transdermal and levetiracetam both increase sedation. Use Caution/Monitor.

            • fentanyl transmucosal

              fentanyl transmucosal and levetiracetam both increase sedation. Use Caution/Monitor.

            • fexofenadine

              levetiracetam and fexofenadine both increase sedation. Use Caution/Monitor.

            • flibanserin

              levetiracetam and flibanserin both increase sedation. Use Caution/Monitor.

            • fluphenazine

              levetiracetam and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              levetiracetam and flurazepam both increase sedation. Use Caution/Monitor.

            • gabapentin

              levetiracetam and gabapentin both increase sedation. Use Caution/Monitor.

            • ganaxolone

              levetiracetam and ganaxolone both increase sedation. Use Caution/Monitor.

            • givinostat

              levetiracetam and givinostat both increase QTc interval. Use Caution/Monitor. If coadministered, obtain ECGs when initiating, during concomitant use, and as clinically indicated. Withhold if QTc interval >500 ms or a change from baseline >60 ms.

            • guanfacine

              levetiracetam and guanfacine both increase sedation. Use Caution/Monitor.

            • haloperidol

              levetiracetam and haloperidol both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              levetiracetam and hydroxyzine both increase sedation. Use Caution/Monitor.

            • iloperidone

              levetiracetam and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              levetiracetam and imipramine both increase sedation. Use Caution/Monitor.

            • isoflurane

              levetiracetam and isoflurane both increase sedation. Use Caution/Monitor.

            • ketamine

              levetiracetam and ketamine both increase sedation. Use Caution/Monitor.

            • ketotifen, drug-eluting contact lens

              levetiracetam and ketotifen, drug-eluting contact lens both increase sedation. Use Caution/Monitor.

            • lamotrigine

              levetiracetam and lamotrigine both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, levetiracetam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, levetiracetam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levocetirizine

              levetiracetam and levocetirizine both increase sedation. Use Caution/Monitor.

            • levorphanol

              levetiracetam and levorphanol both increase sedation. Use Caution/Monitor.

            • loratadine

              levetiracetam and loratadine both increase sedation. Use Caution/Monitor.

            • lorazepam

              levetiracetam and lorazepam both increase sedation. Use Caution/Monitor.

            • loxapine

              levetiracetam and loxapine both increase sedation. Use Caution/Monitor.

            • lumateperone

              levetiracetam and lumateperone both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, levetiracetam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              levetiracetam and lurasidone both increase sedation. Use Caution/Monitor.

            • maprotiline

              levetiracetam and maprotiline both increase sedation. Use Caution/Monitor.

            • meclizine

              levetiracetam and meclizine both increase sedation. Use Caution/Monitor.

            • meperidine

              levetiracetam and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              levetiracetam and meprobamate both increase sedation. Use Caution/Monitor.

            • metaxalone

              levetiracetam and metaxalone both increase sedation. Use Caution/Monitor.

            • methocarbamol

              levetiracetam and methocarbamol both increase sedation. Use Caution/Monitor.

            • methohexital

              methohexital and levetiracetam both increase sedation. Use Caution/Monitor.

            • methsuximide

              levetiracetam and methsuximide both increase sedation. Use Caution/Monitor.

            • midazolam

              levetiracetam and midazolam both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, levetiracetam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • mirtazapine

              levetiracetam and mirtazapine both increase sedation. Use Caution/Monitor.

            • molindone

              levetiracetam and molindone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              levetiracetam and nalbuphine both increase sedation. Use Caution/Monitor.

            • nitrous oxide

              levetiracetam and nitrous oxide both increase sedation. Use Caution/Monitor.

            • nortriptyline

              levetiracetam and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              levetiracetam and olanzapine both increase sedation. Use Caution/Monitor.

            • olanzapine/samidorphan

              levetiracetam and olanzapine/samidorphan both increase sedation. Use Caution/Monitor.

            • oliceridine

              levetiracetam and oliceridine both increase sedation. Use Caution/Monitor.

            • olopatadine intranasal

              levetiracetam and olopatadine intranasal both increase sedation. Use Caution/Monitor.

            • opicapone

              levetiracetam and opicapone both increase sedation. Use Caution/Monitor.

            • opium tincture

              levetiracetam and opium tincture both increase sedation. Use Caution/Monitor.

            • orlistat

              orlistat decreases levels of levetiracetam by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

            • orphenadrine

              levetiracetam and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              levetiracetam and oxazepam both increase sedation. Use Caution/Monitor.

            • paliperidone

              levetiracetam and paliperidone both increase sedation. Use Caution/Monitor.

            • pentazocine

              levetiracetam and pentazocine both increase sedation. Use Caution/Monitor.

            • perampanel

              levetiracetam and perampanel both increase sedation. Use Caution/Monitor.

            • perphenazine

              levetiracetam and perphenazine both increase sedation. Use Caution/Monitor.

            • pheniramine

              levetiracetam and pheniramine both increase sedation. Use Caution/Monitor.

            • pimozide

              levetiracetam and pimozide both increase sedation. Use Caution/Monitor.

            • pomalidomide

              levetiracetam and pomalidomide both increase sedation. Use Caution/Monitor.

            • pregabalin

              levetiracetam and pregabalin both increase sedation. Use Caution/Monitor.

            • primidone

              levetiracetam and primidone both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              levetiracetam and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              levetiracetam and promethazine both increase sedation. Use Caution/Monitor.

            • propofol

              levetiracetam and propofol both increase sedation. Use Caution/Monitor.

            • protriptyline

              levetiracetam and protriptyline both increase sedation. Use Caution/Monitor.

            • pyrilamine

              levetiracetam and pyrilamine both increase sedation. Use Caution/Monitor.

            • quazepam

              levetiracetam and quazepam both increase sedation. Use Caution/Monitor.

            • quetiapine

              levetiracetam and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              levetiracetam and ramelteon both increase sedation. Use Caution/Monitor.

            • remifentanil

              levetiracetam and remifentanil both increase sedation. Use Caution/Monitor.

            • remimazolam

              levetiracetam and remimazolam both increase sedation. Use Caution/Monitor.

            • reserpine

              levetiracetam and reserpine both increase sedation. Use Caution/Monitor.

            • risperidone

              levetiracetam and risperidone both increase sedation. Use Caution/Monitor.

            • rivaroxaban

              levetiracetam will decrease the level or effect of rivaroxaban by unknown mechanism. Use Caution/Monitor.

            • scopolamine

              levetiracetam and scopolamine both increase sedation. Use Caution/Monitor.

            • sevelamer

              sevelamer decreases levels of levetiracetam by increasing elimination. Use Caution/Monitor.

            • sevoflurane

              levetiracetam and sevoflurane both increase sedation. Use Caution/Monitor.

            • sodium oxybate

              levetiracetam and sodium oxybate both increase sedation. Use Caution/Monitor.

            • stiripentol

              stiripentol, levetiracetam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              levetiracetam and sufentanil both increase sedation. Use Caution/Monitor.

            • sufentanil SL

              levetiracetam and sufentanil SL both increase sedation. Use Caution/Monitor.

            • suvorexant

              levetiracetam and suvorexant both increase sedation. Use Caution/Monitor.

            • tapentadol

              levetiracetam and tapentadol both increase sedation. Use Caution/Monitor.

            • tasimelteon

              levetiracetam and tasimelteon both increase sedation. Use Caution/Monitor.

            • temazepam

              levetiracetam and temazepam both increase sedation. Use Caution/Monitor.

            • tetrabenazine

              levetiracetam and tetrabenazine both increase sedation. Use Caution/Monitor.

            • thioridazine

              levetiracetam and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              levetiracetam and thiothixene both increase sedation. Use Caution/Monitor.

            • tiagabine

              levetiracetam and tiagabine both increase sedation. Use Caution/Monitor.

            • tizanidine

              levetiracetam and tizanidine both increase sedation. Use Caution/Monitor.

            • tolcapone

              levetiracetam and tolcapone both increase sedation. Use Caution/Monitor.

            • topiramate

              levetiracetam and topiramate both increase sedation. Use Caution/Monitor.

            • trazodone

              levetiracetam and trazodone both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              levetiracetam and trifluoperazine both increase sedation. Use Caution/Monitor.

            • triprolidine

              levetiracetam and triprolidine both increase sedation. Use Caution/Monitor.

            • valproic acid

              levetiracetam and valproic acid both increase sedation. Use Caution/Monitor.

            • vigabatrin

              levetiracetam and vigabatrin both increase sedation. Use Caution/Monitor.

            • zaleplon

              levetiracetam and zaleplon both increase sedation. Use Caution/Monitor.

            • ziconotide

              levetiracetam and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              levetiracetam and ziprasidone both increase sedation. Use Caution/Monitor.

            • zolpidem

              levetiracetam and zolpidem both increase sedation. Use Caution/Monitor.

            • zonisamide

              levetiracetam and zonisamide both increase sedation. Use Caution/Monitor.

            Minor (16)

            • acetaminophen

              levetiracetam decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • acetaminophen IV

              levetiracetam decreases levels of acetaminophen IV by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • acetaminophen rectal

              levetiracetam decreases levels of acetaminophen rectal by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • atracurium

              levetiracetam decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • biotin

              levetiracetam decreases levels of biotin by unspecified interaction mechanism. Minor/Significance Unknown. Biotin supplementation may be necessary.

            • cisatracurium

              levetiracetam decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • cyanocobalamin

              levetiracetam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • dexmethylphenidate

              dexmethylphenidate increases effects of levetiracetam by decreasing metabolism. Minor/Significance Unknown.

            • levocarnitine

              levetiracetam decreases levels of levocarnitine by unspecified interaction mechanism. Minor/Significance Unknown.

            • pancuronium

              levetiracetam decreases effects of pancuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • rapacuronium

              levetiracetam decreases effects of rapacuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • rocuronium

              levetiracetam decreases effects of rocuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • sage

              sage decreases effects of levetiracetam by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction; some species of sage may cause convulsions.

            • serdexmethylphenidate/dexmethylphenidate

              serdexmethylphenidate/dexmethylphenidate increases effects of levetiracetam by decreasing metabolism. Minor/Significance Unknown.

            • succinylcholine

              levetiracetam decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • vecuronium

              levetiracetam decreases effects of vecuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Asthenia (11-15%)

            Headache (14-19%)

            Infection (11-15%)

            Increased blood pressure (17% in children < 4 years)

            Somnolence (11-15%)

            Drowsiness (2-23%)

            Fatigue (10-11%)

            Anorexia (3-13%)

            Weakness (9-15%)

            Nasopharyngitis (7-15%)

            Cough (2-11%)

            1-10%

            Viral infection (2%)

            Asthma (2%)

            Dizziness (5-9%)

            Nervousness (2-10%)

            Amnesia (2%)

            Anxiety (2-3%)

            Ataxia (3%)

            Depression (2-5%)

            Hostility (10%)

            Paresthesia (2%)

            Sinusitis (2%)

            Diplopia (2%)

            Amblyopia (2%)

            Conjunctivitis (2-3%)

            Albuminuria (4%)

            <1%

            Abnormal hepatic function tests

            Dyskinesia

            Eczema

            Neutropenia

            Decreased hematocrit

            Leukopenia

            Suicidal tendencies

            Hepatitis

            Pancreatitis

            Bone marrow suppression

            Epidermal necrolysis

            Postmarketing Reports

            Hepatic: Abnormal liver function tests, hepatic failure, hepatitis, pancreatitis

            Skin: Alopecia, erythema multiforme; drug rash with eosinophilia and systemic syndrome (DRESS)

            Neurologic: Choreoathetosis, dyskinesia, worsening of seizures

            Hematology: Leukopenia, neutropenia, pancytopenia, thrombocytopenia, agranulocytosis

            Skeletomuscular: Muscle weakness

            Psychological: Panic attack

            General: Weight loss

            Hyponatremia

            Acute kidney injury

            Anaphylaxis and angioedema

            Obsessive-compulsive disorders

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Somnolence and asthenia occurred most frequently within first 4 weeks of treatment; patients should be monitored for signs and symptoms and advised not to drive or operate machinery until they have gained sufficient experience on levetiracetam to gauge whether it adversely affects ability to drive or operate machinery

            As with most antiepileptic drugs, drug should generally be withdrawn gradually because of risk of increased seizure frequency and status epilepticus; if withdrawal needed because of serious adverse reaction, rapid discontinuation can be considered

            Psychiatric reactions: 13.3% of adults and 37.6% of children treated with levetiracetam reported nonpsychotic behavioral symptoms (eg, aggression, agitation, anger, anxiety, apathy, depersonalization, lability, hostility, hyperkinesis, irritability, nervousness, neurosis, and personality disorder) compared to 6.2% and 18.6% of adult and pediatric placebo patients respectively; dose reduction or discontinuation may be required

            Monitor patients for behavioral abnormalities including psychotic symptoms, suicidal ideation, irritability, aggressive behavior, and for new or worsening depression, suicidal thoughts/behavior, and/or unusual changes in mood or behavior

            Serious dermatological reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) reported; median time of onset is reported to be 14-17 days; if signs or symptoms suggest SJS/TEN, use of this drug should not be resumed and alternative therapy should be considered

            May impair ability to operate heavy machinery

            Therapy can cause hematologic abnormalities, including decreases in white blood cell (WBC), neutrophil, and red blood cell (RBC) counts; decreases in hemoglobin and hematocrit; and increases in eosinophil counts; cases of agranulocytosis, pancytopenia, and thrombocytopenia reported in postmarketing setting; a complete blood count is recommended in patients experiencing significant weakness, pyrexia, recurrent infections, or coagulation disorders

            Increases in eosinophil counts observed

            Monitor patients 1 month to <4 years of age for increases in diastolic blood pressure

            Seizure control during pregnancy: Physiological changes during pregnancy may gradually decrease therapeutic plasma concentrations, this is particularly pronounced during the 3rd trimester; closely monitor serum levels during pregnancy and through the postpartum period

            Agranulocytosis reported; in pediatric patients (4 to <16 years of age), statistically significant decreases in WBC and neutrophil counts were seen in patients treated with immediate-release levetiracetam; no patient was discontinued secondary to low WBC or neutrophil counts

            One percent of adult patients and 2% of pediatric patients (4 to 16 years of age) treated with immediate-release levetiracetam experienced psychotic symptoms (paranoia)

            Use caution in renal impairment; adjust dose; use immediate release formulation, instead of the extended release formulation, in patients with ESRD requiring hemodialysis

            Can cause anaphylaxis or angioedema after the first dose or at any time during treatment; if patient develops signs or symptoms of anaphylaxis or angioedema, therapy should be discontinued and patient should seek immediate medical attention; therapy should be discontinued permanently if clear alternative etiology for reaction cannot be established

            Drug reaction with eosinophilia and systemic symptoms (DRESS)

            • DRESS, also known as multiorgan hypersensitivity, has been reported in patients taking antiepileptic drugs, including levetiracetam; these events can be fatal or life-threatening, particularly if diagnosis and treatment do not occur as early as possible
            • DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling, in association with other organ system involvement, such as hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis, sometimes resembling an acute viral infection
            • Eosinophilia is often present; because this disorder is variable in its expression, other organ systems not noted here may be involved; it is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident
            • If such signs or symptoms are present, the patient should be evaluated immediately; this drug should be discontinued if an alternative etiology for signs or symptoms cannot be established
            • Advise patients to avoid discontinuing medications without speaking to a healthcare provider
            • Sudden discontinuation can lead to uncontrolled seizures
            • Instruct patients to immediately go to emergency room if any unusual symptoms or reactions develop, including a rash, at any time while taking levetiracetam or clobazam
            • Prompt recognition and early treatment is important for improving DRESS outcomes and decreasing mortality
            • Symptoms of DRESS generally start 2-8 weeks after initiating
            • DRESS can also be confused with other serious skin reactions (eg, SJS, TEN)
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women; prolonged experience in pregnant women has not identified a drug-associated risk of major birth defects or miscarriage, based on published literature, which includes data from pregnancy registries, and reflects experience over two decades

            In animal studies, levetiracetam produced evidence of developmental toxicity, including teratogenic effects, at doses similar to or greater than human therapeutic doses

            Use during pregnancy only if the potential benefit justifies the potential risk to the fetus

            Drug blood levels may decrease during pregnancy; physiological changes during pregnancy may affect drug concentration; decrease in drug plasma concentrations has been observed during pregnancy; this decrease is more pronounced during third trimester; dose adjustments may be necessary to maintain clinical response

            Enroll patients in the North American Antiepileptic Drug pregnancy registry; 1-888-233-2334 or visit http://www.aedpregnancyregistry.org

            Lactation

            Drug is excreted in human milk; there are no data on effects of drug on breastfed infant, or on milk production

            Unknown if distributed in human breast milk

            Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal conditio

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Antiepileptic mechanism unknown; may inhibit voltage-depedent N-type calcium channels; may bind to synaptic proteins that modulate neurotransmitter release; through displacement of negative modulators may facilitate GABA-ergic inhibitory transmission

            Pyrrolidone derivative

            Absorption

            Bioavailability: 100%

            Peak plasma time: 1 hr (immediate release); 4 hr (extended release)

            Distribution

            Protein bound: <10%

            Metabolism

            Metabolism: Hepatic enzymatic hydrolysis

            Metabolites: Inactive

            Elimination

            Half-life: 6-8 hr (increased in elderly or renal disease)

            Total body clearance: 0.96 mL/min/kg

            Renal clearance: 0.6 mL/min/kg; 4 mL/min/kg (metabolite)

            Clearance ~40% higher in children

            Dialyzable: Yes

            Excretion: Urine (66%)

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            Administration

            IV Use

            IV preparation: Dilute IV solution in 100 mL compatible solution

            IV administration: Infuse IV over 15 minutes

            Compatabilities

            • Solutions: NS, LR, D5W
            • Additive/syringe: lorazepam, diazepam, valproate sodium

            Oral Administration

            May take with or without food

            Use oral solution for children who weigh ≤20 kg

            Elepsia XR, Keppra XR: Swallow tablet whole; do not chew, split, crush, or cut tablets

            Spritam

            • Developed with ZipDose technology, which uses 3-dimensional printing to create a porous formulation of the antiepileptic that disintegrates rapidly with a sip of liquid, even at a high dose of up to 1000 mg
            • May take with or without food
            • Place the whole tablet on the tongue with a dry hand and follow with a sip of liquid
            • Swallow only after tablet disintegrates in mouth (mean disintegration time 11 seconds [range 2-27 seconds])
            • Tablet should not be swallowed intact
            • Instruct patients not to push the tablet through the foil; the foil should be peeled from the blister by bending and lifting the peel tab around the blister seal so the table does not break

            Storage

            Unused vials: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)

            May store diluted IV solution in PVC bags at 15-30°C (59-86°F) for up to 24 hr

            Extended-release or immediate release tablets: Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)

            Solution: Store at 20-25°C (68-77°F)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Roweepra oral
            -
            1,000 mg tablet
            Roweepra oral
            -
            750 mg tablet
            Roweepra oral
            -
            500 mg tablet
            Elepsia XR oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            1,000 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            750 mg tablet
            levetiracetam oral
            -
            500 mg tablet
            levetiracetam oral
            -
            250 mg tablet
            levetiracetam oral
            -
            100 mg/mL solution
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            levetiracetam intravenous
            -
            500 mg/5 mL vial
            Keppra intravenous
            -
            500 mg/5 mL vial
            Spritam oral
            -
            1,000 mg tablet
            Spritam oral
            -
            750 mg tablet
            Spritam oral
            -
            500 mg tablet
            Spritam oral
            -
            250 mg tablet
            Roweepra XR oral
            -
            750 mg tablet
            Roweepra XR oral
            -
            500 mg tablet
            Keppra oral
            -
            1,000 mg tablet
            Keppra oral
            -
            250 mg tablet
            Keppra oral
            -
            750 mg tablet
            Keppra oral
            -
            500 mg tablet
            Keppra oral
            -
            100 mg/mL solution
            Keppra XR oral
            -
            500 mg tablet
            Keppra XR oral
            -
            750 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            levetiracetam oral

            LEVETIRACETAM TABLET - FOR ORAL SUSPENSION

            (LEE-ve-tye-RA-se-tam)

            COMMON BRAND NAME(S): Spritam

            USES: Levetiracetam is used with other medications to treat seizures (epilepsy). It belongs to a class of drugs known as anticonvulsants. Levetiracetam may decrease the number of seizures you have.

            HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking levetiracetam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually twice a day.Carefully remove the tablet(s) from the foil packet as directed by the product package. Do not push the tablet(s) through the foil. Dry your hands before handling the medication. Place each dose on the tongue and take a sip of liquid. Allow the medication to completely dissolve before swallowing it. Do not swallow the tablet(s) whole.The tablet(s) may also be placed in a cup with a small amount of liquid (1 tablespoon/15 milliliters). Swirl the mixture gently, then drink all of the mixture right away. To make sure you have taken all of the medication, add another small amount of liquid to the cup to rinse it, and drink it right away.The dosage is based on your medical 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.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.Do not stop taking this medication without consulting your doctor. Your seizures may become worse when the drug is suddenly stopped. Your dose should be gradually decreased.Tell your doctor if your seizures lasts, change, or gets worse.

            SIDE EFFECTS: Drowsiness, dizziness, unusual tiredness, or weakness may occur. These side effects are more common during the first 4 weeks and usually lessen as your body adjusts to the medication. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, such as: loss of coordination (such as difficulty walking and controlling muscles), mental/mood changes (such as irritability, aggression, agitation, anger, anxiety), signs of anemia (such as unusual tiredness that doesn't go away, pale skin, fast breathing, fast heartbeat), easy bruising/bleeding.A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.Levetiracetam can commonly cause a rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe reaction. Tell your doctor right away if you develop any rash.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, such as: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking levetiracetam, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease (such as dialysis treatment), mental/mood disorders (such as depression).This drug may make you dizzy or drowsy, especially during the first month of treatment. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, ride a bicycle, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (such as prescription drugs, nonprescription drugs, and herbal products).Children may be more sensitive to the side effects of the drug, especially mental/mood changes (such as irritability, aggression, agitation, anger, anxiety, depression, thoughts of suicide). Children younger than 4 years may be at greater risk for increased blood pressure while using this drug (see also Notes section).Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness or loss of coordination. These side effects can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breastfeeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: orlistat.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, loss of consciousness.

            NOTES: Do not share this medication with others.Lab and/or medical tests (such as kidney function, complete blood count) may be done while you are taking this medication. In children younger than 4 years, blood pressure may also be monitored. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised March 2024. Copyright(c) 2024 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.