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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 Crazy Meds 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 dosage1. More and more doctors are agreeing with us2. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.

1.  Keppra-XR’s dosage and doses

Per the PI sheet it’s two 500mg tablets (or whatever your dosage is) of Keppra XR once a day.
For the immediate-release version it’s one 500mg tablet twice a day.

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.

2.  Best way to take / special instructions for taking Keppra-XR

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.

3.  Keppra-XR’s titration (dosage increase)

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 (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare.

4.  How to stop taking Keppra-XR

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.

5.  Discontinuation symptoms

Pretty much the same as all AEDs: headaches, spaciness, return of symptoms (i.e. seizures).

6.  Notes, tips, helpful hints, etc. for discontinuing Keppra-XR

‹ Expanded Side Effects | Keppra-XR Index | Expanded Likelihood of Working & Comparisons with Other Meds ›
Crazy Meds Comprehensive Keppra-XR pages

Bibliography

1 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.

2 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.

*Link to Topiramate in the treatment of partial and generalized epilepsy Scroll down to the section “Practical use of topiramate”


Date created Tuesday, 04 October 2011 at 11:12:28 Page Creator: Kassiane S. Last edited by:

Crazy Meds’ Recommendations on How Much to Take, How to Increase the Dosage, and How to Stop Taking Keppra-XR is copyright 2011 Kassiane S.

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