Levetiracetam: uses, mood effects and cautions

Levetiracetam is used to treat epilepsy by preventing seizures from happening. The NHS describes the action simply as blocking the signals in the brain that can cause seizures. It is prescription-only, and Keppra is the brand named by the NHS.

It is typically taken every day rather than only after a seizure, so the benefit comes from regular use over weeks and months, with the aim of fewer or no seizures.

One practical strength of levetiracetam is the range of formulations. The NHS lists tablets, granules, a liquid and orodispersible tablets. Each is handled differently, so it helps to know which you have been given.

Most people take levetiracetam once or twice a day, with or without food. The NHS does not quote fixed doses; it says you may start on a low dose that the doctor raises over a few weeks, so the number on your label may change early in treatment.

If you forget a dose, take it as soon as you remember unless the next one is close, in which case skip it. The NHS says not to take two doses to make up. When treatment is to stop, the dose is normally reduced gradually, and that is a decision for the prescriber rather than something to try alone.

Common effects listed by the NHS are dizziness, feeling sleepy or tired, headaches, difficulty controlling body movements, nausea or vomiting, tremor, and feeling agitated, irritable or aggressive. If you are tired, sleepy or dizzy after a dose, the NHS says not to drive, ride a bike or use machinery until it has gone.

The mood effects deserve a clear mention because family members often notice them first. The NHS says levetiracetam may not be suitable if you have had low mood or thoughts of harming or killing yourself, so that history should be shared with the doctor before starting.

Rare serious effects are an allergic reaction, skin reactions such as Stevens-Johnson syndrome (painful blisters or peeling skin), and kidney problems with very little urine, confusion or swollen legs, ankles or feet. The NHS says to call 999 for anaphylaxis or Stevens-Johnson syndrome and NHS 111 for other serious effects.

The list of named interactions on the NHS page is short. It mentions macrogol, a laxative, and methotrexate, used for arthritis and other conditions. It also says not to use the herbal supplement St John's wort alongside levetiracetam. Any other medicine, herbal remedy, vitamin or supplement should still be mentioned to the doctor.

On alcohol, the NHS says it is best not to drink because it can increase side effects such as sleepiness.

The NHS says levetiracetam can be used in pregnancy when necessary, and the doctor will individually weigh risk and benefit. Typically the lowest effective dose is prescribed, a higher dose of folic acid may be recommended, and delivery in hospital may be advised so that monitoring is available.

Breastfeeding is not usually recommended because the medicine passes into breast milk, but a doctor may continue it if the benefit to the mother outweighs the risk to the baby. If you are worried about your baby, talk to a health professional or use NHS 111. The Bumps website is pointed to for further reading on medicines in pregnancy.

If you take more than prescribed, ask a pharmacist straight away, or use NHS 111 if you cannot reach one. If told to go to A&E, use an ambulance rather than driving yourself.

Many other anti-seizure medicines exist, and the choice depends on seizure type, other conditions, age and pregnancy plans. The guide to epilepsy medication choices on this site explains how specialists compare them.