Section 01 · Monograph
Levetiracetam
Reviewed Nov 2026FDA label
KeppraSV2A ligand
- Forms
- Tab: 250, 500, 750, 1000mg | XR: 500, 750mg | Sol: 100mg/mL | IV: 100mg/mL
- Dose
- 1000-3000mg/day
- MOA
- Binds synaptic vesicle protein SV2A
Indications
- Adjunctive therapy for partial-onset seizures, age 1 month and olderFDA-labeled
- Adjunctive therapy for myoclonic seizures in juvenile myoclonic epilepsy, age 12+FDA-labeled
- Adjunctive therapy for primary generalized tonic-clonic seizures in idiopathic generalized epilepsy, age 6+FDA-labeled
Off-Label Uses
- Status epilepticus (IV, second/third-line)Off-label
- Seizure prophylaxis in acute brain injury/neurosurgeryOff-label
- Bipolar disorder (limited evidence, not routinely recommended)Off-label
Mechanism of Action
- Binds synaptic vesicle protein SV2A, modulating neurotransmitter release
- Distinct from classic AED mechanisms (does not significantly act on Na+ channels, GABA-A, or T-type Ca2+ channels)
- Also shown to inhibit N-type calcium channels and reduce excessive neuronal synchronization
Full Dosing
Adult / usual
- Adults: initiate 500mg BID, titrate by 500mg BID every 2 weeks to a max of 1500mg BID (3000mg/day)
- IV formulation: given as 15-minute infusion when oral route not feasible, same total daily dose
- Must be withdrawn gradually — abrupt discontinuation can precipitate withdrawal seizures
Renal
- Renal impairment: dose reduction required based on CrCl per label dosing table
- Hemodialysis: supplemental dose recommended after each dialysis session
Pediatric
- Pediatric (partial-onset seizures, 1 month+): weight-based dosing per label, titrated similarly to adult schedule
Contraindications
- Known hypersensitivity to levetiracetam or any component of the formulation (angioedema/anaphylaxis reported)
Drug Interactions
- Minimal hepatic metabolism (partially hydrolyzed by blood esterases) — low CYP-mediated interaction potential
- No clinically significant pharmacokinetic interaction with valproate, phenytoin, carbamazepine, or other common AEDs
Adverse Effects
- Common (adults): somnolence, asthenia, dizziness, infection
- Common (pediatric): fatigue, aggression, nasal congestion, decreased appetite, irritability
- Behavioral abnormalities including psychotic symptoms, irritability, and aggressive behavior — monitor for psychiatric signs
- Suicidal ideation/behavior — monitor for new or worsening depression or mood changes
Monitoring Parameters
- Renal function for dose adjustment
- Mood and behavioral changes, especially early in treatment
- Seizure frequency and control
Pregnancy & Lactation
- Plasma levels may decrease during pregnancy, most pronounced in the third trimester — monitor levels closely through the postpartum period
- Based on animal data, may cause fetal harm
- Consider enrollment in the North American Antiepileptic Drug Pregnancy Registry