Levetiracetam 750mg Tablets
It is used to treat seizures.
Drug Class
Anticonvulsant; Antiepileptic
Pharmacologic Class
Pyrrolidine derivative; Synaptic Vesicle Glycoprotein 2A (SV2A) Ligand
Pregnancy Category
Not available
FDA Approved
Nov 2000
DEA Schedule
Not Controlled
Overview
What is this medicine?
Levetiracetam is a medication used to treat certain types of seizures (epilepsy). It works by affecting specific proteins in the brain to help stabilize electrical activity and reduce the frequency of seizures.
How to Use This Medicine
Taking Your Medication
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. You can take this medication with or without food. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel well. To establish a routine, take your medication at the same time every day. Swallow the tablet whole - do not chew or crush it. However, if needed, you can break the tablet in half, but be sure not to chew or crush it.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry location, avoiding the bathroom. Protect it from heat and light to preserve its effectiveness. Keep all medications in a safe place, out of the reach of children and pets, to prevent accidental ingestion.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses, as this can increase the risk of side effects.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. You can take this medication with or without food. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel well. To establish a routine, take your medication at the same time every day. Swallow the tablet whole - do not chew or crush it. However, if needed, you can break the tablet in half, but be sure not to chew or crush it.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry location, avoiding the bathroom. Protect it from heat and light to preserve its effectiveness. Keep all medications in a safe place, out of the reach of children and pets, to prevent accidental ingestion.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses, as this can increase the risk of side effects.
Lifestyle & Tips
- Take exactly as prescribed, do not stop taking suddenly without consulting your doctor, as this can lead to increased seizures.
- Avoid driving or operating heavy machinery until you know how this medication affects you, as it can cause dizziness or drowsiness.
- Avoid alcohol, as it can worsen side effects like dizziness and drowsiness.
- Maintain regular sleep patterns, as sleep deprivation can trigger seizures.
- Carry identification indicating you have epilepsy and are taking antiepileptic medication.
Available Forms & Alternatives
Available Strengths:
- Levetiracetam 100mg/ml Solution
- Levetiracetam 1000mg Tablets
- Levetiracetam 250mg Tablets
- Levetiracetam 750mg Tablets
- Levetiracetam 500mg Tablets
- Levetiracetam ER 500mg Tablets
- Levetiracetam ER 750mg Tablets
- Levetiracetam 500mg/5ml Inj, 5ml
- Levetiracetam ER 500mg Tablets
- Levetiracetam ER 750mg Tablets
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to a maximum of 1500 mg twice daily (3000 mg/day).
Dose Range:
1000 - 3000 mg
Condition-Specific Dosing:
partialOnsetSeizures:
Initial: 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to a maximum of 1500 mg twice daily.
myoclonicSeizures:
Initial: 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to a maximum of 1500 mg twice daily.
generalizedTonicClonicSeizures:
Initial: 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to a maximum of 1500 mg twice daily.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established for tablets. Oral solution/IV available for infants âĨ1 month.
Child:
Partial-onset seizures (4 to <16 years): Initial 10 mg/kg twice daily. Increase by 10 mg/kg twice daily every 2 weeks to a maximum of 30 mg/kg twice daily (60 mg/kg/day).
Adolescent:
Partial-onset seizures (âĨ16 years): Same as adult dosing.
Dose Adjustments
Renal Impairment:
Mild:
CrCl 50-80 mL/min: 500-1000 mg twice daily.
Moderate:
CrCl 30-49 mL/min: 250-750 mg twice daily.
Severe:
CrCl <30 mL/min: 250-500 mg twice daily.
Dialysis:
ESRD patients on dialysis: 500-1000 mg once daily. A supplemental dose of 250-500 mg is recommended after dialysis.
Hepatic Impairment:
Mild:
No adjustment needed.
Moderate:
No adjustment needed.
Severe:
Consider dose reduction for severe hepatic impairment with concomitant renal impairment, as levetiracetam clearance may be reduced.
Pharmacology
Mechanism of Action
The precise mechanism of action is unknown. Levetiracetam binds to the synaptic vesicle protein 2A (SV2A) in the brain, which is thought to modulate neurotransmitter release by affecting vesicle exocytosis. It does not inhibit voltage-gated sodium channels, nor does it enhance GABAergic transmission or inhibit glutamate. It may also modulate N-type calcium channels and partially reverse the reduction in GABA- and glycine-gated currents induced by zinc and beta-carbolines.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 100%
Tmax:
Approximately 1 hour (oral)
FoodEffect:
Food does not affect the extent of absorption, but may slightly decrease the rate.
Distribution:
Vd:
Approximately 0.5-0.7 L/kg
ProteinBinding:
<10%
CnssPenetration:
Yes
Elimination:
HalfLife:
Approximately 7 Âą 1 hours (adults); 5-6 hours (children); 10-11 hours (elderly); 19-30 hours (ESRD)
Clearance:
Approximately 0.96 mL/min/kg (adults)
ExcretionRoute:
Renal (primarily unchanged drug)
Unchanged:
Approximately 66%
Pharmacodynamics
OnsetOfAction:
Rapid (within hours of first dose)
PeakEffect:
Not directly measured for antiepileptic effect; peak plasma concentrations reached in ~1 hour.
DurationOfAction:
Approximately 12 hours (consistent with twice-daily dosing)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Fatigue
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Hallucinations (seeing or hearing things that are not there)
Severe dizziness or fainting
Changes in balance or coordination
Difficulty walking
Suicidal thoughts or behaviors (especially in people with a history of suicidal thoughts or actions)
New or worsening symptoms of depression, anxiety, or mood changes, such as:
+ Feeling nervous, restless, or irritable
+ Panic attacks
+ Other changes in mood or behavior
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious skin reactions, which may also affect internal organs
+ Signs of severe skin reactions include:
- Red, swollen, blistered, or peeling skin
- Red or irritated eyes
- Sores in the mouth, throat, nose, eyes, genitals, or skin
- Fever
- Chills
- Body aches
- Shortness of breath
- Swollen glands
Low blood cell counts, which can increase the risk of:
+ Infections
+ Bleeding problems
+ Anemia
+ Signs of low blood cell counts include:
- Fever
- Chills
- Sore throat
- Unexplained bruising or bleeding
- Feeling extremely tired or weak
Angioedema, a severe and potentially life-threatening reaction, which may cause:
+ Swelling of the hands, face, lips, eyes, tongue, or throat
+ Difficulty breathing
+ Difficulty swallowing
+ Unusual hoarseness
Other Possible Side Effects
Most people experience few or no side effects while taking this medication. However, some common side effects may occur, including:
Diarrhea
Stomach pain
Upset stomach
Vomiting
Decreased appetite
Dizziness
Drowsiness
Fatigue
Weakness
Nose or throat irritation
Difficulty sleeping
Headache
Flu-like symptoms
If you experience any of these side effects or any other symptoms that concern you, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Fatigue
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Hallucinations (seeing or hearing things that are not there)
Severe dizziness or fainting
Changes in balance or coordination
Difficulty walking
Suicidal thoughts or behaviors (especially in people with a history of suicidal thoughts or actions)
New or worsening symptoms of depression, anxiety, or mood changes, such as:
+ Feeling nervous, restless, or irritable
+ Panic attacks
+ Other changes in mood or behavior
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious skin reactions, which may also affect internal organs
+ Signs of severe skin reactions include:
- Red, swollen, blistered, or peeling skin
- Red or irritated eyes
- Sores in the mouth, throat, nose, eyes, genitals, or skin
- Fever
- Chills
- Body aches
- Shortness of breath
- Swollen glands
Low blood cell counts, which can increase the risk of:
+ Infections
+ Bleeding problems
+ Anemia
+ Signs of low blood cell counts include:
- Fever
- Chills
- Sore throat
- Unexplained bruising or bleeding
- Feeling extremely tired or weak
Angioedema, a severe and potentially life-threatening reaction, which may cause:
+ Swelling of the hands, face, lips, eyes, tongue, or throat
+ Difficulty breathing
+ Difficulty swallowing
+ Unusual hoarseness
Other Possible Side Effects
Most people experience few or no side effects while taking this medication. However, some common side effects may occur, including:
Diarrhea
Stomach pain
Upset stomach
Vomiting
Decreased appetite
Dizziness
Drowsiness
Fatigue
Weakness
Nose or throat irritation
Difficulty sleeping
Headache
Flu-like symptoms
If you experience any of these side effects or any other symptoms that concern you, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- New or worsening depression, anxiety, or other mood changes
- Thoughts of self-harm or suicide
- Unusual changes in behavior or mood (e.g., aggression, agitation, irritability)
- Severe skin rash or blistering
- Fever, swollen glands, or other signs of infection
- Unusual bruising or bleeding
- Extreme tiredness or weakness
- Yellowing of the skin or eyes (jaundice)
- Dark urine
- Swelling in the face, eyes, lips, or tongue
- Difficulty breathing or swallowing
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have kidney disease or are undergoing dialysis.
This list is not exhaustive, and it is crucial to discuss all your medications (including prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine whether it is safe to take this medication in conjunction with your other medications and health issues.
Remember, do not start, stop, or modify the dosage of any medication without first consulting your doctor to ensure your safety.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have kidney disease or are undergoing dialysis.
This list is not exhaustive, and it is crucial to discuss all your medications (including prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine whether it is safe to take this medication in conjunction with your other medications and health issues.
Remember, do not start, stop, or modify the dosage of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Until you understand how this drug affects you, avoid operating a vehicle or engaging in activities that require alertness. Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter medications that may impair your reactions, consult with your doctor.
Regularly undergo blood tests and other laboratory examinations as directed by your doctor. If you experience changes in your seizure patterns or severity after initiating this medication, discuss these changes with your doctor.
Do not abruptly discontinue this medication without consulting your doctor, as this may increase your risk of seizures. If you need to stop taking this drug, your doctor will instruct you on how to gradually taper off the medication to minimize potential risks.
If you are 65 years or older, exercise caution when using this medication, as you may be more susceptible to side effects. Similarly, when administering this drug to children, use it with caution, as they may have a higher risk of experiencing certain side effects. Not all formulations of this medication are suitable for all children, so consult with your doctor before giving it to a child.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor, as you will need to discuss the potential benefits and risks to both you and your baby. Be aware that this medication may be less effective in controlling seizures during pregnancy, and if you have concerns, consult with your doctor.
Regularly undergo blood tests and other laboratory examinations as directed by your doctor. If you experience changes in your seizure patterns or severity after initiating this medication, discuss these changes with your doctor.
Do not abruptly discontinue this medication without consulting your doctor, as this may increase your risk of seizures. If you need to stop taking this drug, your doctor will instruct you on how to gradually taper off the medication to minimize potential risks.
If you are 65 years or older, exercise caution when using this medication, as you may be more susceptible to side effects. Similarly, when administering this drug to children, use it with caution, as they may have a higher risk of experiencing certain side effects. Not all formulations of this medication are suitable for all children, so consult with your doctor before giving it to a child.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor, as you will need to discuss the potential benefits and risks to both you and your baby. Be aware that this medication may be less effective in controlling seizures during pregnancy, and if you have concerns, consult with your doctor.
Overdose Information
Overdose Symptoms:
- Somnolence
- Agitation
- Aggression
- Decreased level of consciousness
- Respiratory depression
- Coma
What to Do:
Call 911 or your local emergency number immediately. For poison control, call 1-800-222-1222. There is no specific antidote. Treatment is supportive and may include gastric lavage or emesis. Hemodialysis can remove levetiracetam.
Drug Interactions
Moderate Interactions
- Methotrexate (may decrease methotrexate clearance, increasing toxicity; monitor methotrexate levels)
- Orlistat (may reduce levetiracetam absorption; separate administration times)
Monitoring
Baseline Monitoring
Renal function (serum creatinine, eGFR)
Rationale: Levetiracetam is primarily renally excreted; dose adjustment is required in renal impairment.
Timing: Prior to initiation of therapy.
Routine Monitoring
Seizure frequency and severity
Frequency: Regularly, at each follow-up visit.
Target: Reduction or elimination of seizures.
Action Threshold: Increased seizure activity or lack of efficacy may warrant dose adjustment or alternative therapy.
Behavioral/mood changes (e.g., aggression, irritability, depression, suicidal ideation)
Frequency: Regularly, especially during initial titration and dose changes.
Target: Absence of significant adverse behavioral effects.
Action Threshold: New or worsening behavioral symptoms; consider dose reduction or discontinuation.
Complete Blood Count (CBC)
Frequency: Periodically, if clinically indicated (e.g., signs of infection, unexplained bruising/bleeding).
Target: Within normal limits.
Action Threshold: Significant abnormalities (e.g., neutropenia, thrombocytopenia) may warrant investigation.
Renal function (serum creatinine, eGFR)
Frequency: Periodically, especially in elderly patients or those with pre-existing renal impairment.
Target: Stable renal function.
Action Threshold: Decline in renal function may necessitate dose adjustment.
Symptom Monitoring
- Drowsiness
- Dizziness
- Fatigue
- Weakness
- Irritability
- Aggression
- Anxiety
- Depression
- Mood changes
- Suicidal thoughts or behavior
- Coordination problems
- Gait disturbance
- Nausea
- Vomiting
- Loss of appetite
- Skin rash
- Signs of infection (fever, sore throat)
- Unusual bleeding or bruising
Special Patient Groups
Pregnancy
Levetiracetam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Data from pregnancy registries and observational studies have not shown a consistent increase in the risk of major congenital malformations with levetiracetam exposure during pregnancy, but some studies suggest a possible increased risk of minor anomalies or specific malformations (e.g., cardiovascular).
Trimester-Specific Risks:
First Trimester:
Potential for increased risk of major congenital malformations, though data are mixed and generally reassuring compared to other AEDs.
Second Trimester:
Continued exposure, monitor maternal and fetal well-being.
Third Trimester:
Continued exposure, monitor maternal and fetal well-being. Consider monitoring levetiracetam levels as clearance may increase during pregnancy.
Lactation
Levetiracetam is excreted into human breast milk. The decision to breastfeed should consider the potential for infant exposure, the benefits of breastfeeding, and the benefits of therapy to the mother. Monitor breastfed infants for drowsiness, irritability, and poor feeding.
Infant Risk:
Low to moderate risk. Monitor for sedation, poor feeding, and developmental milestones.
Pediatric Use
Dosing is weight-based for children. Behavioral side effects (e.g., irritability, aggression, anxiety) may be more prominent in pediatric patients. Close monitoring for these effects is crucial.
Geriatric Use
Start with a lower dose and titrate slowly due to the higher probability of decreased renal function in elderly patients. Monitor renal function closely. Elderly patients may be more susceptible to CNS side effects like dizziness and somnolence.
Clinical Information
Clinical Pearls
- Levetiracetam is generally well-tolerated and has a favorable drug interaction profile due to minimal hepatic metabolism.
- Behavioral side effects (irritability, aggression, mood changes) are common, especially during initiation or dose escalation, and can be a reason for discontinuation.
- Patients should be advised not to abruptly discontinue levetiracetam due to the risk of increased seizure frequency or status epilepticus.
- No routine therapeutic drug monitoring is required for levetiracetam, but levels can be checked if adherence or pharmacokinetic variability is suspected.
- Available in various formulations (tablet, oral solution, extended-release tablet, IV) offering flexibility in administration.
Alternative Therapies
- Lamotrigine
- Topiramate
- Valproic acid
- Carbamazepine
- Oxcarbazepine
- Lacosamide
- Zonisamide
- Phenytoin
- Gabapentin
- Pregabalin
Cost & Coverage
Average Cost:
Varies, typically $20-$100 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others or take someone else's medication. This medication is accompanied by a Medication Guide, which provides crucial information for patients. Please read this guide carefully and review it again whenever you receive a refill of this medication. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider for guidance. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount consumed, and the time it occurred.