Table of Contents (hide)
- 1. Names, Availability, Brand vs. Generic Issues, Forms
- 1.1 US brand name: Keppra
- 1.2 Available as Keppra in these countries1
- 1.3 Other trade name(s) for Keppra used in these countries1
- 1.4 Generic Name and Availability
- 1.5 levetiracetam is available in these countries2
- 1.6 Branded generic names3
- 1.7 Specific generics with complaints, or preferred generics manufacturers
- 1.8 Generics with independently-tested bioequivalence
- 1.9 Forms and Classes
- 2. Approved and Off-Label Uses
- 3. Chances of Working & Comparisons with Other Meds
- 4. Dosage, Titration, and Discontinuation
- 5. Pros, Cons, and Interesting Information
- 6. Side Effects and Pregnancy Category
This is essentially everything we know about Keppra (levetiracetam) on two big-ass pages. On this page is brand / trade names to odds of working and comparisons with other meds, or pretty much everything most people want to know. Page two is pharmacokinetics to the bibliography, or:
I’m sure somebody wants to about 0.1% of people who read about a med look at it.
The titles for most sections link to the pages for those sections. While all the information is on these two comprehensive pages, the individual section pages go into a little more detail about what it all means.
Just because a drug is available in one country doesn’t mean you can get it everywhere. Even if a medication is available elsewhere, it won’t necessarily have the same brand, or trade name everywhere it is sold.
1.2 Available as Keppra in these countries1
Argentina, Australia, Canada, Chile, EU, Hong Kong, India, Ireland, Japan, Korea, Malaysia, Mexico, New Zealand, Peru, Philippines, Singapore, Taiwan, Thailand, Turkey, UK
1.3 Other trade name(s) for Keppra used in these countries1
- 开浦兰: China
- イーケプラ (E-Kepura): Japan
- 케프라 (Kepeura): Korea
A drug’s generic, or international nonproprietary name (INN) is how it is uniquely identified around the world. Or not. The generic version of a med is are often available in other countries long before they are in the US.
|US Generic available?||Yes|
1.5 levetiracetam is available in these countries2
- Generic IR levetiracetam is also available in the EU, Ireland, New Zealand, UK,
- A generic version of Keppra-XR is available in India.
1.6 Branded generic names3
- Kevtam: Australia
- Kepcet: Australia
- Kopodex: Chile
- levetirasetaamille: Finland
- Levitam: Australia
- 左乙拉西坦: China
- 레비티라세탐 (rebitirasetam): Korea
In theory the generic version of a med is the same as the brand-name version. In practice that is usually, but not always the case. Especially with crazy meds. If we know of any problems with particular generics, or if some generics are better than others, we’ll let you know.
We don’t have the names of any generics to be wary of. Yet. However, plenty of problems have been reported with generic levetiracetam.
KEY FINDINGS:Of the 260 patients (34%) being prescribed LEV (generic and brand name) during the study period, 105 (42.9%) were switched back to brand name LEV by their treating physicians. Reasons for switch back included increase in seizure frequency (19.6% vs. 1.6%; p < 0.0001) and adverse effects (AEs) (3.3%). AEs included headache, fatigue, and aggression. Patient age was associated with switchback when controlling for gender, epilepsy classification, and treatment characteristics [relative risk (RR) 2.44; 95% confidence interval (CI) 2.09–2.84; p < 0.05)]. An increase in seizure frequency subsequent to generic substitution was associated with polytherapy compared to monotherapy (3.225; 1.512–6.880; p < 0.05).
SIGNIFICANCE: A significant proportion of patients in our cohort on generic LEV required switch back to the branded drug. Careful monitoring is imperative because a compulsory switch from branded to generic LEV may lead to poor clinical outcomes, with risk of AEs and increased seizure frequency.--Clinical experience with generic levetiracetam in people with epilepsy
On a smaller scale, four people who lost seizure control after being switched from brand to generic. And here’s another four people with epilepsy due to brain tumors who lost seizure control after being switched to generic.
Keppra XR (extended release):
- 500 mg tablets are white, oblong-shaped, film-coated with “UCB 500XR” in red on one side.
- 750 mg tablets are white, oblong-shaped, film-coated with “UCB 750XR” in red on one side.
Keppra immediate release (IR):
- 250 mg tablets are blue, oblong-shaped, scored, * film-coated with “ucb 250” on one side.
- 500 mg tablets are yellow, oblong-shaped, scored, film-coated with “ucb 500” on one side.
- 750 mg tablets are orange, oblong-shaped, scored, film-coated with “ucb 750” on one side.
- 1000 mg tablets are white, oblong-shaped, scored, film-coated with “ucb 1000” on one side.
|Primary Drug Class:||AntiepilepticDrugs/Anticonvulsants|
|Additional Drug Categories:|
Drugs are officially approved to be used for certain things, and they may be approved for one thing in one country but something else entirely in another.4
- Keppra-XR (Extended Release): as adjunctive therapy (combined with another medication) in the treatment of partial onset seizures in patients 16 years old or older with epilepsy.
- Keppra (immediate release/IR) & oral solution:
- as adjunctive therapy in the treatment of partial onset seizures in adults and children 4 years old and older with epilepsy.
- as adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years old and older with juvenile myoclonic epilepsy (JME).
- as adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy.
- Injection for Intravenous Use (IV). The same as the IR version, except:
- It’s approved only for people 16 years old and older.
- It’s to be used only if someone isn’t able to take the tablets or drink the vile-tasting grape Keppra-Ade.
- IV Keppra isn’t intended for long-term use, and should be replaced by a tablet or oral solution form as soon as possible.
Meds are often prescribed for conditions or people they aren’t approved to treat. This is known as off-label prescribing. Some off-label prescribing is so common that lots of people think the medication is a first-line treatment for the condition it’s prescribed to treat.
Boy do we have off label uses! Keppra is like Neurontin, in that it’s being prescribed for practically anything (these guys certainly want to throw it at everything). Unlike Neurontin, it works…but when used for something other than epilepsy it usually needs one thing to work. See if you can figure it out.
- Monotherapy for partial epilepsies.
- Including motor and sensory epilepsia partialis continua (EPC). EPC is one of the scariest and weirdest things to witness or experience.
- Monotherapy for generalized epilepsies, including:
- post-hypoxic and post-encephalic myoclonus
- negative myoclonus
- Various idiopathic (i.e. fuck if the doctors know what caused it, odds are you were born with it and it didn’t pop up until just now) myoclonic, tonic-clonic and/or absence seizures.
- absence seizures - plus a good example of what happens if you suddenly stop taking Keppra, and how Keppra will forgive you and work just as well.
- and the dreaded Lennox-Gastaut syndrome. With a 50% to 100% reduction of certain seizure types along with an increase in the kids’ alertness. Talk about win-win!
- Keppra is also used for seizures and other damage caused by traumatic brain injury, where it’s as good as Dilantin (phenytoin), the gold standard med.
- Keppra is also good for tumor-induced epilepsy.
- It’s really good for tumor-induced epilepsy.
- Including preventing seizures prior to and during surgery.
- And stopping the seizures in children with brain tumors without interfering with any of the chemo and other meds they take.
- And stopping the vomiting caused by chemo along with stopping the seizures.
- Keppra just generally improves the quality of life of people with brain tumor-related epilepsy.
- When you’ve got 75 of 82 patients (91%) seizure free
- and Keppra could actually help prevent some forms of brain cancer from spreading so UCB damn well better be doing more clinical trials for another approved indication! If they don’t want to pay for it some cancer research charity should.
- Naturally enough IV Keppra is used to deal with status epilepticus.
- It works best when used immediately and by itself.
- In case you haven’t cried enough lately, IV Keppra works well for critically ill children who have gone into status. Too bad they still need to keep collecting data one kid at a time to figure out the best way to use it.
- For bipolar disorder Keppra’s best used to deal with the most extreme, out-of-control manias you have around.
- Keppra stops mania fast, like an antipsychotic.
- Either as an add-on medication
- or all by itself.
- It’s worked for rapid cycling, but only when everything else didn’t.
- As with epilepsy, one of Keppra’s best features is that if you stop taking it, Keppra tends to work just as well if you stop it and restart it. So if you were crazy and thought you were cured, or because your manias are seasonal and you don’t need a potent anti-manic certain times of the year, Keppra has its place in the bipolar pharmacopeia.
- Migraines, both in adults and kids.
- IV Keppra is good for status migrainosus - migraines that last for more than 72 fucking hours.
- Neuropathic pain, including:
- chronic pain in multiple sclerosis
- trigeminal neuralgia
- And as an adjunctive analgesic, along with traditional opiods, in neoplastic plexopathies -not like I have any idea what that is, other than it hurts a lot and it’s involved with cancer.
- The data are mixed when it comes to Keppra and anxiety disorders. In this study it looks pretty good, while in this study it’s just so-so, and in this study the placebo worked better.
- Like all anticonvulsants, Keppra is being tested as a means to get clean when hooked on other drugs. Alcohol seems to be the most promising, although the data are mixed.
- And Keppra is used successfully for all sorts of movement disorders:
- It works well for antipsychotics-resistant Tourette Syndrome
- But when it comes to Tourette Syndrome in general, the data are mixed.
- Along the same lines, Keppra seems to be great for levodopa-induced dyskinesia in Parkinson’s disease. There are a dozen small studies supporting that, but nothing about Parkinson’s itself.
- Tardive dyskinesia.
- Meige’s syndrome.
- Generalized dystonia.
- Dyskinetic cerebral palsy and hemiplegic cerebral palsy.
- Huntington disease, but watch out! Keppra has caused dyskinesias in people with Huntington’s.
Figure it out? The magic word: refractory. Keppra is the go-to drug when nothing else will work, or whatever you take barely works.
When all else fails and you’ve run out of other options, the experimental use of some drug may be your best chance at treating something. Be careful! Otherwise safe meds can be downright dangerous when used for some things.
- Keppra has been successfully used for Landau-Kleffner syndrome.
- Keppra is OK for Unverricht-Lundborg disease.
- Eyelid myoclonia with absences (Jeavons syndrome). While the data are mixed with this one, when you’ve got an obscure and difficult-to-treat condition, anything that works for somebody is probably worth trying.
- Angelman syndrome. Including when the kid goes into nonconvulsive status epilepticus.
- premenstrual dysphoric disorder (PMDD). Although this is where an abstract is nowhere near enough data. Sure, it worked great for 6 out of 7 women, but what about the other 116 who were screened out of the study in the first place?
- Stiff person syndrome.
- Mad Cow Disease! Really. To control the myoclonic seizures associated with Creutzfeldt-Jakob. Here it is again, although that one is just bitching about vomiting. Neither has an abstract.
- Fragile X-associated tremor/ataxia syndrome. This is a problem carriers of Fragile X syndrome have, not the people with it.
- Hemifacial spasm.
Alas, Keppra doesn’t work for absolutely everything. There are some things it can’t deal with.
- Essential tremor - You know it’s an epic fail when they pull the plug on a study after it did absolutely jack shit for 15 out of a planned 45 people, before they could find the remaining 30. The results from this study are only slightly less bad, but in Spanish.
- Chronic daily headache
- spinal cord injury pain
- The data are mixed with autism. It didn’t help with anything this study was looking at, and only some of the things this study was looking at.
- Behavioral and cognitive side effects from prednisone therapy. Hulk still smash. And from personal experience - Keppra doesn’t do squat to counter any of these types of side effects from steroid therapy or similar symptoms from the condition it’s treating.
- Postmastectomy pain syndrome. Keppra is great for brain cancer, but absolutely worthless for boob cancer.
- Charles Bonnet syndrome. Stick with Tegretol or Depakote, a Keppra just makes it worse.
Just because a medication is approved or commonly prescribed for a particular condition doesn’t necessarily mean you should be taking it for that condition. There could be a drug that might be better to try first, or at least talk to your doctor about trying first, or the condition you have isn’t bad enough to warrant medication at all.
- Your neurologist said so.
- You have brain cancer.
- Your liver is next to useless.
- All the usual meds failed or barely work.
- You’re currently severely depressed.
- You have a history of psychosis (One off-label use nobody dares try: Keppra for schizophrenia).
- Especially if you have a history of psychosis caused by AEDs.
- Extra especially if the psychosis happened after your seizures were under control.
Two of the most important things to know when deciding on which med is the best for a particular condition5: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Unfortunately because no one is quite sure exactly what causes various conditions - further complicated when everything is a spectrum disorder - and they’re never really sure about how a med works in the first place, especially when there are lots of contradictory and/or questionable studies,6 we can only give you an idea somewhat less vague than support groups and PI sheets, but certainly more accurate than the implied “it fixes everything all the time!” promises of pharmaceutical advertising.
See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.
As an add-on, or even as monotherapy for epilepsy, the odds of Keppra working are pretty damn good. In the clinical trials and larger studies it averages out to half the people who take it have their seizures reduced by at least 50%, with about 15% becoming seizure-free. Most of them keep taking it after three years and four years. That’s for both immediate-release Keppra and extended-release Keppra XR.
The numbers on how many people discontinued Keppra due to side effects are the lowest we’ve seen in clinical trials for any med. Seriously. Look at this one. 1.8% of people stopped taking Keppra vs. 4.3% who stopped taking the placebo because the side effects of the placebo sucked too much! So it’s no surprise that Keppra improves your general quality of life.
Where Keppra really shines is for people with refractory (otherwise uncontrollable) epilepsy. They’ve done two big-ass, global Safety of Keppra as Adjunctive Therapy in Epilepsy (SKATE) studies on just that. The results:
- In the first one 50.1% of patients had seizure frequency reduction of >=50%; 15.8% of patients were seizure free;60.4% showed at least moderate improvement.
- In the second one, much smaller one 44.0% of patients had a >=50% reduction in seizure frequency, and 17.7% became seizure free.
In some of the other studies we found on refractory epilepsies:
- In an open-label study of Keppra as an add-on in Korean adults with uncontrolled partial epilepsy The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The >=50% and >=75% responder rates were 45.4% and 36.1%, respectively. 17 out of 92 patients were seizure-free.
- In this study of people with either partial or generalized epilepsy who were taking two or more other AEDs The 49.4% of people with partial seizures and 51.4% with generalized seizures had a 50% or more reduction in seizure frequency. 26/191 (13.6%) were seizure-free. 10.5% (18/172) were seizure-free for at least 6 months and 6.4% (11/172) were seizure-free for at least 1 year.
- For refractory generalized epilepsies Most patients (68%) reported some improvement in seizure frequency on levetiracetam including 16% who became seizure free.
- In a similar small study with 11 patients using only Keppra and 8 taking Keppra and something else, 13 became seizure-free, and 5 achieved a 50–75% reduction in seizure frequency. No change in seizure frequency was observed in 1 patient.
- Keppra XR as an add-on to one to three AEDs. Thirty-four (43%) Keppra XR and 23 (29.1%) placebo patients experienced >=50% reduction in seizures, with eight (10.1%) taking Keppra XR one (1.3%) getting the placebo becoming seizure-free.
- One of the most difficult to treat types of epilepsy (or any brain cooties) is when it starts young (childhood onset) and isn’t quickly controlled. In this study of the long-term use of Keppra in severe childhood-onset epilepsy Thirty-five patients (27.1%) were initial responders of which 5 became seizure free. After 3 years was 22.5% kept taking Keppra. Those numbers seem low compared with the above studies, but that’s actually really good for this situation.
- You know what really, really sucks when you’re epileptic? Having part of your brain cut out to control your seizures (resection), but it doesn’t work. Once again, Keppra to the rescue! 76.1% (16 of 21) had a reduction in seizures, including 10 (47.6%) patients who became seizure free. Although 3 of those 16 developed severe psychoses 4–9 months later, which is a higher rate than people with a history of crazy. But can you blame them?
In the long-term:
- Following up six months eight years later Keppra (along with whatever else they were taking) was working for 36.1% of people taking it. Of them, 38.6% had at least a 50% reduction in seizures and 20.1% had at least a 75% reduction. Sixty-five (4.6%) patients were seizure-free over their entire treatment period, compared with 167 (11.7%) and 126 (8.9%) during their last 6 and 12 months of follow-up. Ninety-seven (19.8%) of 491 patients who received only one other antiepileptic drug (AED) were seizure-free during their last 6 months. 14.4% (205 patients) reduced the number of meds they took and 5.5% (79 patients) were taking only Keppra.
- As with vanilla epilepsy, Keppra improves your quality of life.
You’d think with so many off-label uses of Keppra, this can go on forever! Actually, it’s not easy to get real numbers for off-label applications.
- Using Keppra by itself (monotherapy) to treat epilepsy is technically off-label. But it’s included in several of the studies and reviews cited above and below. Additionally we have Keppra for generalized epilepsy with myoclonic seizures, and Keppra as monotherapy for people with partial epilepsy. The odds are the same as when using Keppra as an add-on: it averages to about half the people who take it will have the number of seizures they have cut in half, if not more, with around 15% being seizure free.
- If you have seizures caused by brain tumors, especially glioma, you need to be taking Keppra. Response rates are typically high, like 91% seizure free.
- As for everything else, including bipolar disorder, Keppra is your go-to drug if nothing else works.
3.4 Keppra versus other AntiepilepticDrugs/Anticonvulsants for approved treatments:
Since Keppra is approved only as an add-on, there aren’t many head-to-head studies that focus purely on efficacy. Most are about side effects.
- Keppra vs. Topamax for long-term treatment of chronic, refractory epilepsies. Two of the best meds for some of the most difficult to treat types of epilepsy. 301 on Keppra and 429 taking Topamax. The results: Keppra sucked less and worked better. After one year was 65.6% of patients were still taking Keppra vs. 51.7% for Topamax-treated patients. At two years it was 45.8% still on Keppra and 38.3% still on Topamax. Adverse events led to drug discontinuation in 21.9% of Topamax-treated patients compared to 6.0% of Keppra-treated patients. The number of patients discontinuing treatment because of lack of efficacy was similar for both groups. Topamax was somewhat better in seizure freedom rates, between 11.6% and 20.0% for Topamax and between 11.1% and 14.3% Keppra LEV per 6-months interval.
- Keppra vs. Topamax for short-term treatment of refractory partial epilepsy. Keppra wins hands down. 61 patients received Keppra and 61 Topamax. During the 15 days of the study 26 people (42.6%) taking Keppra were seizure free compared to 10 (16.4%) taking Topamax.
- IV Keppra vs. Diastat for prolonged, repetitive seizures. Distat is like a Valium suppository, except in gel form, so you have to manually rub it around with your finger up in someone’s butthole. In this study they had to do it more than once with each patient. The results: it’s a tie, but they work a lot better together. I think we can guess which method the people in the hospitals prefer.
- AED geezer cagematch! Tegretol vs. clobazam vs. Neurontin vs. Keppra vs. Lamictal vs. Trileptal vs. Dilantin (phenytoin) vs. Topamax vs. Depakote vs. Zonegran in people 55 or older with a variety of types of epilepsy. The winner: Lamictal, with 79% of people staying on it for one year or longer and 54% seizure-free. Keppra was a close second with 73% staying on it and 43% seizure-free. The same was true even for refractory epilepsy, with 47.4% responding to Lamictal and 38.9% responding to Keppra. The biggest loser: Trileptal, with only 24% staying on and 4% remaining seizure-free.
- Keppra vs. Tegretol vs. Lamictal. This study investigated the risk factors of cardiovascular disease in patients with epilepsy who take different AEDs. The results: Uh, well, Tegretol kind of made things a little worse, especially with women, who gained weight on it and Lamictal due to inactivity. Tegretol also raised total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein in both men and women.
- Keppra vs. Lamictal vs. phenobarbital in people with Alzheimer’s. You know someone is old if they’re taking pheno for epilepsy. The results: a tie! At least when it comes to seizures. Lamictal made them feel better and Keppra helped with the Alzheimer’s symptoms a little, neither of which is surprising.
- Keppra vs. Lamictal - which one gets you more pissed off? Finally, a useful study! The results: a tie. Both in control of partial seizures and improvement of mood and lessening hostility, Keppra works as well as Lamictal.
- Along similar lines, Keppra vs. Topamax, which one makes you crazier? The results: Topamax is somewhat more likely to make you crazier, especially if you become seizure-free. How is being seizure-free related to going batshit crazy? The term is “forced normalization.”
- IV Keppra vs. Dilantin (phenytoin) for seizure prophylaxis after neurological injury. In English: to prevent seizures after something like a traumatic brain injury (TBI). The results: Keppra works a lot better and sucks a lot less than Dilantin (phenytoin), which is the gold standard for TBI-induced epilepsy.
- Of course someone had to compare the costs of Keppra vs. phenytoin for TBI-induced seizures. That’s where phenytoin wins, at $37 a week vs. $480. Unless you have some good insurance, starting with phenytoin is probably the best way to deal with this.
- Keppra XR vs. immediate-release Keppra, which sucks less? For a drug with a side effect profile lower than placebo, this is a tough call. The result: no difference, but what can you expect from a study run by the company that makes Keppra? At least the authors question the methodology.
- Keppra vs. Tegretol. Keppra worked for 78% vs 69% taking Tegretol. But this study was really about the cognitive effects. Which do you think made them less stupid? Executive functions improved in 15% and deteriorated in 5% of patients taking Keppra; the opposite pattern was seen with those taking Tegretol.
- Now this just isn’t fair. Comparing Keppra with Topamax for cognitive side effects. Really?
- 30 patients with focal epilepsy treated with Keppra and 21 patients treated with Topamax. The results: No change with the people taking Keppra, cognitive speed, verbal fluency, and short-term memory all got worse in those taking Topamax.
- 260 people taking Topamax vs. 142 taking Keppra for 18 months. The results: After a year and a half only 46% stayed on Topamax while 61% kept taking their Keppra, and it was intolerable cognitive effects that caused most people to quit taking Topamax.
- However, 40 people taking Topamax vs. 39 taking Keppra after one year. The results: a tie. There was no difference. Not only that, memory improved for some people taking Topamax. This study actually proves something we’ve been saying for years: at the right dosage Topamax can make you brain better.
- AED stupidity cagematch! Depakote vs. Dilantin (phenytoin) vs. Keppra vs. Lamictal vs. Neurontin vs. Tegretol vs. Topamax vs. Trileptal vs. Zonegran in which makes you the stoopidedist. The wiener:
Stupamax DopamaxTopamax, with 21.5% of people reporting intolerable (where they had to stop taking it) cognitive side effects. In second place was Zonegran with 14.9% and in third place was Trileptal with 11.6%. Keppra scored fairly high with 10.4%, but that includes people who were taking Keppra along with one or more other AEDs. When taking only Keppra it had the fewest (no number in the abstract) number of reported cognitive side effects.
- Long-term AED tolerability cagematch. Which AED can more people out of 828 stand for two years? Keppra vs. Lamictal vs. Trileptal vs. Topamax vs. Zonegran. The winner: Lamictal with 74.1%, followed by Zonegran with 60.2%, Triletpal? with 58.8%, Keppra with 53.6%, and Topamax with 44.2%. Most were discontinued due to inefficacy (29.5%) and/or sedating (?!) side-effects (20.5%), usually within 6 months. There were the usual drug-specific side effects that caused people to quit as well, like Keppra’s irritability, the Lamictal rash, and the ever-popular kidney stones from Topamax and Zonegran.
- AED rash cagematch. Tegretol vs. clobazam vs. Felbatol (felbamate) vs. Neurontin vs. Lamictal vs. Keppra vs. Trileptal vs. phenobarbital vs. Dilantin (phenytoin) vs. primidone vs. Gabitril vs. Topamax vs. Sabril (vigabatrin) vs. Depakote vs. Zonegran as to which is most likely to cause rashes. Hmmmm, I wonder which one it could be? And the winner is…Dilantin (phenytoin)! Because this study included people who got rashes from another AED. Some of the numbers: phenytoin 5.9% overall, 25.0% in those with another AED rash, Lamictal 4.8% overall, 14.4% with another AED rash, and Tegretol 3.7% overall, 16.5% with another rash.
- Keppra vs. Dilantin (phenytoin) for glioma (brain tumor)-induced epilepsy. Seventy-six patients were identified, 25 treated with phenytoin and 51 with Keppra. The results: a tie, at least as far as seizure control goes. Keppra sucked a lot less. Plus 36% of the patients taking phenytoin needed dose adjustments unrelated to breakthrough seizures vs. 10% taking Keppra.
- Switching to Keppra vs. staying on Dilantin (phenytoin) after surgery to remove glioma (brain tumors). The results: Keppra worked better and sucked a lot less, except when it came to mood. Each med was just as likely to cause depression, and no one taking phenytoin became emotionally unstable.
- Keppra vs. phenytoin for seizures after supratentorial neurosurgery. Whatever the hell a supratentorial craniotomy is, there’s a good chance of seizures afterwards. As usual Dilantin (phenytoin) is the standard treatment. This study followed 105 people taking Keppra and and 210 taking phenytoin for a year. The usual results: Keppra worked better and sucked a lot less.
- Keppra vs. valproate vs. phenytoin for status epilepticus. Keppra is the only modern AED used to treat status epilepticus - the potentially fatal, never-ending seizure. The first med used is almost always a benzodiazepine, usually Ativan. The results: the valproates win, and Keppra loses, working only about half the time.
- Keppra vs. Valium vs. Benadryl vs. valproic acid vs. placebo: which do junkies like best? I’m not making this up. Valium is the obvious winner with a score of 9 out of 10. Keppra placed second (of actual meds) with a score of 6/10, followed by Benadryl (diphenhydramine) with 5/10 and poor old valproic acid 2/10. Nobody likes valproic acid. The score for the placebo wasn’t given, but it scored higher than Keppra.
One of the most important aspects of any medication is how to go about taking it. This includes:
- how much to take (the dosage or dose)
- when and how often to take it (dosing schedule or doses)
- how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).
This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.
We here at Crazymeds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage7. More and more doctors are agreeing with us8. You and your doctor can always discuss increasing the dosage when you need to in advance.
We’re good with that, unless you’re experiencing psychiatric effects, especially irritability and rage. In which case we recommend taking Keppra XR twice a day and immediate-release Keppra three times a day. You can split the immediate-release tablets, and they don’t even make Keppra XR in the 1000mg size.
If they start you on 500mg of Keppra XR, which is perfectly sane, you’re screwed when it comes to taking it twice a day, as that is currently the smallest size now available.
If you are taking Keppra XR only once a day, you’ll probably want to try taking it at night to begin with, as it’s far more likely to make you sleepy than to keep you awake.
Taking Keppra with food will delay Keppra’s peak availability by an average of an hour and a half, and can sometimes cut down on how much Keppra you absorb by up to 20%. What does that mean as far as taking it is concerned? You’ll be better off taking Keppra on an empty stomach, but it won’t be that big of a deal if you need to take it with food in the very unlikely chance it gives you tummy troubles.
According to UCB you can start Keppra XR at 1000mg once a day and that’s it, sort of like Invega. They said the same thing about the immediate-release version as well, although with two 500mg doses. Although 500mg is the low-end of the therapeutic range. If you haven’t achieved symptom control, or you lose symptom control, your doctor may increase your dosage by 1000mg a day (taken once a day for KeppraXR and two 500mg dose for immediate-release Keppra) each week until you hit the maximum recommended dosage of 3000mg a day.
One moderately-sized double-blind study even concludes you can start at 2000–4000mg a day if required. Even Dr. Faught in the edition of PeerView in Review on traditional and new antiepileptic drugs thinks thinks that Keppra can be titrated as stated, unlike any of the others (including Ortho-McNeil’s Topamax, the sponsor of the program). Guess what? I disagree.
There is a REASON they make 250mg tablets, and there is a REASON they are so easy to cut in half! I don’t think most people need to start quite that low, but 500mg, taken as 250 twice a day, is reasonable to start if you’re not completely flipping out. That’s where the off-label bipolar studies show them starting, by the way. Then a 250mg step-up weekly, 125mg if it hits really hard. Not every 5 days, A WEEK. SEVEN DAYS. Those extra 2 days can make a big difference in getting used to a med. If less than traditional doses work for someone, then fine and wonderful. I am a big believer in the correct dose isn’t necessarily what the PI sheet says, it is the one that works.
One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others it can be a nightmare.
Slowly, unless being on Keppra is sucking serious ass. And this is why I don’t like starting a med at a therapeutic dose. OK. End soapbox. Generally, the way you went up—was it in 250mg increments, 500mg increments? Please say it wasn’t in 1000mg increments. How you went up on Keppra is how you should go down from Keppra —500 to 250 every 5 to 7 days.
Pretty much the same as all AEDs: headaches, spaciness, return of symptoms (i.e. seizures).
Every med has its good points and its bad points. This is what we think those are.
Doctors don’t have the time to tell you everything about a drug. Patient information leaflets leave out a lot. Even if the PI sheet covers everything the language is so dense and obtuse that the good stuff is often lost in information overload. Most meds have something interesting about them.
- Low side effect profile. How low?
- As in fewer side effects than the placebos in several of the clinical trials.
- As in trying to kill yourself with Keppra will just make you a little loopy. Seriously. This guy took 126 500mg tablets and all he had was blurry vision and ataxia. Both his red and white blood cell counts were low for about two months, but that was it.
- Much less chance of your flipping out on it when compared to other anticonvulsants (E.g. Keppra: 10% of epileptics with previous histories of psychiatric or serious epileptic flippage had issues. Topamax: 24% of similar people had issues.)
- Tends to make people smarter, not dumber like most anticonvulsants.
- Even people starting with learning disabilities can get a bit of a boost.
- Also, unlike many anticonvulsants (or any type of prescription medication in general) it’s so easy on your liver you can take it after a freaking liver transplant!
- It starts working right away,
- and many people can start at or near the therapeutic dose if required-it was designed that way.
- One researcher describes it as having, “close to ideal pharmacokinetic properties.”
- A lot of the side effects it DOES have are psychiatric.
- Reports from the field (a.k.a. anecdotal evidence) suggest the most common are the deep, sometimes suicidal depression. At least you can’t kill yourself with Keppra.
- Another favorite is the Keppra rage, although this one seems to be overhyped, and the XR version may have dealt with that for many people in any event.
- Far less frequent, but still reported, are hallucinations - one woman I know with epilepsy had deep philosophical conversations with a ghost every night.
- And there’s this case report of a kid getting a bit psychotic on Keppra. Those kind of suck-especially when no one bothers to warn you that they might happen.
- Keppra doesn’t mess with, like, ANYTHING. In that it has practically no drug-drug interactions. That in and of itself is pretty interesting.
- Girls get more bang for their buck than boys with Keppra. Per the PI sheet women absorb 20% more of Keppra than men do.
- Keppra is by far The. Worst-Tasting. Pill. on the market. Everyone who whines about how bad Lamictal tastes should lick a split Keppra. Then a split Topamax - but only if you have one left over from a prescription you no longer use, or is a 25mg tablet that is part of a larger dose. Topamax’s taste warrants a mention in its medication guide. It turns out you’re not supposed to split Topamax because that hoses its rate of absorption, and isn’t really about the taste, so you don’t want to screw around with something like that just for a taste test.
- If you take Keppra, Tegretol may not work as well for you if you try it later. But if you take Tegretol, it will have no effect on how well Keppra will work. At least, that’s the case for rats.
- The super interesting stuff is really geeky and can be found on the Pharmacokinetics and Pharmacodynamics pages. Like the reason there aren’t any drug-drug interactions with any crazy meds is because it’s metabolized in a way that very few meds are, and most of them are cancer meds. Which may also explain why it works so well for brain tumor-induced epilepsy, or could be just a weird coincidence.
Potential side effects are used as a rationalization to not take a medication. Many people will stop taking an otherwise working drug because of one or more relatively minor, or often temporary side effects. There may even be ways to counter or mitigate side effects.
It all comes down to a very important question: which sucks less?
No matter what crazy med you take, it will probably make you feel spacey and generally out of it for the first few days (i.e. don’t operate heavy machinery), as well as make you drowsy. Even stimulants can make you drowsy. Keppra will probably affect your dreams as well, and there’s no way to tell if that will be a temporary or permanent side effect. Don’t be surprised if your stomach and/or other parts of your GI system complain for at least the first few days.
Most everyone gets at least one or two of these.
- Like most AEDs: sleepiness, headache, and dizziness/vertigo.
- What most crazy meds have as uncommon-to-rare, but are common side effects for Keppra:
- Muscle weakness
- Various kinds of infections-rhinitis, pharyngitis, sinusitis, and assorted nose problems.
- Another nice thing about Keppra - its side effects are almost always dosage-dependent. So the more you take, the more likely and/or more severe the side effects will be. Why is that nice? Because it’s predictable. Few things about epilepsy and AEDs are predictable.
You may or may not get one or more of these.
- The mood problems-depression, psychosis, hostility, anxiety in various forms (I know, it’s supposed to be good for anxiety. But yet…drugs are weird…).
- Appetite changes one way or another.
- Paresthesia, aka that fun tingling in your extremities like Topamax does.
If you have these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER. NOW!
The only potentially dangerous side effects Keppra has are the same as every AED on the planet. They’re just even less likely to happen than with any of the others.
- Like all AEDs it can eat your blood. I.e. it can cause various blood dyscrasia (bad stuff), including
- Like all AEDs it can eat your skin. I.e. it can cause potentially deadly skin disorders:
- Stevens-Johnson syndrome (SJS better known as the Lamictal Rash)
- toxic epidermal necrolysis (TEN)
- erythema multiforme (similar to SJS, usually not as bad)
You won’t get these. Unless you already have and that’s why you’re here.
- Peace-Love-and-Fluffy-Bunnies-Not-Manic-Just-Happy! Ok, so Kassiane is the only one who got that for very long.
- Status gelasticus. An AED exacerbating, or even causing seizures is neither freaky nor rare. Status gelasticus though is a freaky rare type of seizure. In this poor girl’s case she had eight straight hours of bursts of laughter every 15–20 seconds.
- Reduce the dosage.
- We’ve found that the psychiatric side effects like depression, psychosis, and especially rage can sometimes be mitigated by taking the immediate release form three times a day instead of twice a day. It doesn’t always work, but the track record is pretty good, so it’s worth a shot.
We don’t have any data at all on if that works with Keppra XR form.
- Another way to deal with psychiatric side effects: Take Lamictal.
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1 EU: European Union. Currently Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. Not all drugs approved in any one EU country are approved in all, but most crazy meds approved in several EU countries are at least obtainable in all EU countries on the European mainland. I'm not sure about Britain, Cyprus, Ireland, and Malta.
The UK and Ireland are listed separately because we're a primarily English-language site. Plus the UK tends to be more independent on more matters than any other EU member state, so it should probably be listed separately no matter what language a site like this is in.
While the EU is moving toward one brand name for the same med, that's not going to happen overnight. And people will still refer to meds by old brand names. So we'll list old brand names until they vanish.
2 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.
3 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin**, and they are owned by Pfizer***, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.
4 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.
5 Assuming you were correctly diagnosed in the first place.
6 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.***** That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science******* and Why Most Published Research Findings Are False********. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.********
7 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.
8 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy****, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.
*Article I, Section 8 of the US Constitution
**Greenstone Pharmaceuticals, makers of gabapentin
***Pfizer, owner of Parke-Davis and Greenstone
****Topiramate in the treatment of partial and generalized epilepsy
*****Drug studies favoring sponsors the study.
******Why Current Publication Practices May Distort Science
*******Why Most Published Research Findings Are False
********unpublished clinical trials
Date created Tuesday, 04 October 2011 at 11:12:28 Page Creator: Last edited by: JerodPoore on September 26, 2013, at 10:24 AM
Keppra Comprehensive Rundown Part 1 by is copyright 2011
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]