Levetiracetam, commonly known as Keppra, is an antiepileptic medication used to treat various types of seizures. It’s considered a second-generation anticonvulsant and has become increasingly popular due to its favorable safety profile and broad spectrum of activity.
Generic name: Levetiracetam
Brand names: Keppra, Keppra XR, Spritam, Elepsia XR
Pharmacologic class: Pyrrolidine derivative
Therapeutic class: Anticonvulsant, antiepileptic
Mechanism of action: While the exact mechanism remains not fully understood, levetiracetam is thought to bind to synaptic vesicle protein SV2A, reducing neurotransmitter release and helping prevent seizure activity.
Indications for use:
- Partial-onset seizures in patients one month and older
- Myoclonic seizures in patients 12 years and older
- Primary generalized tonic-clonic seizures
- Adjunctive therapy for various types of epilepsy
Precautions and contraindications:
- Hypersensitivity to levetiracetam or pyrrolidone derivatives
- Patients with renal impairment
- Pregnancy (Category C)
- History of behavioral problems or psychiatric conditions
- Elderly patients
- Patients with a history of suicidal thoughts or behavior
Drug Interactions
- Carbamazepine may decrease levetiracetam levels
- Oral contraceptives may have reduced effectiveness
- Probenecid can affect renal clearance
- Methotrexate may increase toxicity risk
- Alcohol may increase drowsiness and dizziness
Adverse Effects
- Somnolence and fatigue
- Dizziness and coordination problems
- Behavioral changes (aggression, anxiety, depression)
- Headache
- Infection (particularly upper respiratory)
- Decreased appetite
- Nausea and vomiting
- Memory impairment
- Weakness
- Possible increased risk of suicidal thoughts
Administration Considerations
Available preparations:
- Oral tablets: 250mg, 500mg, 750mg, 1000mg
- Extended-release tablets: 500mg, 750mg
- Oral solution: 100mg/mL
- Injectable solution: 100mg/mL
Dosages:
Adults and children ≥16 years: Initially 500mg twice daily, may increase by 1000mg/day every 2 weeks to maximum 3000mg/day.
Pediatric dosing varies by age and weight.
Nursing Considerations for Keppra
Related Nursing Diagnoses
- Risk for injury related to seizure activity
- Disturbed thought processes related to medication side effects
- Risk for falls related to dizziness and coordination problems
- Anxiety related to medication side effects
- Risk for Noncompliance related to complex medication regimen
Nursing Assessment
- Assess seizure history, including frequency, type, and triggers
- Complete neurological assessment before administration
- Evaluate mental status and mood changes
- Monitor renal function through laboratory values
- Assess for suicidal ideation or behavioral changes
Nursing Interventions
- Monitor seizure activity and maintain seizure precautions
- Implement fall precautions due to potential dizziness
- Monitor CBC, renal function tests, and liver function tests
- Observe for behavioral changes or mood alterations
- For IV administration:
- Dilute in 100mL compatible solution
- Administer over 15 minutes
- Monitor injection site for irritation
Patient Teaching Associated with Keppra
- Do not stop taking Keppra abruptly as this may trigger seizures
- Take medication exactly as prescribed, at the same times each day
- If a dose is missed:
- Take as soon as remembered if within 6 hours
- Skip the missed dose if it’s almost time for the next dose
- Never take double doses
- Report any unusual mood changes, depression, or suicidal thoughts immediately.
- Avoid alcohol while taking Keppra
- Keep regular appointments for blood work and monitoring
- Maintain a seizure diary to track effectiveness
- Store at room temperature, away from moisture and heat
- Inform healthcare providers about pregnancy plans or if breastfeeding
- Always carry medical identification indicating epilepsy, and Keppra use
Note: This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult with a pharmacist for complete information.
References
- Patel SI, Birnbaum AK, Cloyd JC, Leppik IE. Intravenous and Oral Levetiracetam in the Emergency and Hospital Setting: A Comparison of Adverse Effects. Epilepsy Behav. 2021;114:107078.
- Vossler DG, Weingarten M, Gidal BE. Summary of Antiepileptic Drugs Available in the United States of America: Working Toward a World Without Epilepsy. Epilepsy Curr. 2020;20(1S):1S-24S.
- Landmark CJ, Johannessen SI, Tomson T. Clinical Use of Antiepileptic Drug Monitoring. Ther Drug Monit. 2022;44(1):10-21.
- Greenfield LJ Jr. Molecular mechanisms of antiseizure drug activity at GABAA receptors. Seizure. 2023;68:102-108.
