Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.
> Keppra (levetiracetam) Review
The Keppra (levetiracetam) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.
Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences
Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Keppra (levetiracetam) provides what the educated consumer wants, highlighting its use as, and comparing it with other AntiEpilepticDrugs. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Keppra (levetiracetam), and consumer experiences.
Primary Drug Class
A review of Keppra’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.
- 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:
- 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.
Drugs sometimes have different approvals in different countries.2 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.
Approved Uses Outside of the US
Clinically Significant or Otherwise Common Off-Label Uses
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.
Injury & Tumor-Induced Epilepsy
- For bipolar disorder Keppra’s best used to deal with the most extreme, out-of-control manias you have around.
Headaches and Other Aches and Pains
- 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:
Figure it out? The magic word: refractory. Keppra is the go-to drug when nothing else will work, or whatever you take barely works.
Less Common/Experimental Off-Label Uses
Alas, Keppra doesn’t work for absolutely everything. There are some things it can’t deal with.
Potentially dangerous off-label uses
A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.
Onset of Action
Not very. Like, as in one-to-two days not very.
Even for refractory epilepsy Keppra can start working in one day.
Efficacy for its Approved Indications
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.
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?
- 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 Dopamax Topamax, 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.
These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.
A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.
Why/When Keppra (levetiracetam) Should Be Recommended
- Your neurologist said so.
- You have brain cancer.
- Your liver is next to useless.
- All the usual meds failed or barely work.
- You get more happy-happy joy-joy manic than scary psychotic manic
- And you tend to get manic far more often, and to a much greater extent, than depressed.
- Believe it or not, that is a real. nasty. problem.
- That’s the sort of bipolar people who aren’t bipolar or familiar with bipolar disorder want to be. I’ll trade them mine and my wrecked marriage for something nice and stable in their life anytime.
Why/When Keppra (levetiracetam) Should Not Be Recommended
- 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.
A review of Keppra’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.
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.
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 aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.
How to Discontinue
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).
Notes, Tips, etc. About Discontinuing Keppra
Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Keppra (levetiracetam) for its approved indications and clinically-significant or otherwise common off-label uses.
- Low side effect profile. How low?
- 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.
When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”
Interesting Things Doctors Rarely Tell Their Patients
- 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.
What Keppra (levetiracetam) is Best Known for
Being the AED that will either fix you when nothing else can - even if you’re taking it for something other than epilepsy, or kill you because it’ll make you suicidally depressed and/or so enraged at the world that you’ll die because half-a-dozen cops had to tase you.
Noted Traits & Effects
That under normal circumstances (i.e. special snowflakes aren’t taking it), Keppra has no pharmacokinetic drug-drug interaction. It doesn’t even interact with warfarin, and warfarin interacts with practically every drug on the planet.
A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.
- Drowsiness/fatigue - even when taking stimulants in some circumstances.
- Insomnia, instead of or alternating with the drowsiness.
- Assorted other minor GI complaints (constipation, diarrhea, etc.)
- Generally feeling spacey / out of it
- Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
- Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.
Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.
Common Adverse Events
* 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.
Uncommon Adverse Events
* 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.
Potentially Dangerous Adverse Events
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
- leukopenia and neutropenia (low white cell count)
- thrombocytopenia (low platelets count)
- pancytopenia (low everything count, you might as well have water in your veins)
- 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)
Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.
Freaky Rare Side Effects:
* 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.
Ways to counter / minimize / mitigate / deal with some side effects
- 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.
Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.
Available as Keppra in these countries
Argentina, Australia, Canada, Chile, EU, Hong Kong, India, Ireland, Japan, Korea, Malaysia, Mexico, New Zealand, Peru, Philippines, Singapore, Taiwan, Thailand, Turkey, UK
Other trade name(s) for Keppra used in these countries
- 开浦兰: China
- イーケプラ (E-Kepura): Japan
- 케프라 (Kepeura): Korea
Generic Name and Availability
|US Generic name/INN:||levetiracetam|
|US Generic available?||Yes|
levetiracetam is available in these countries4
- Generic IR levetiracetam is also available in the EU, Ireland, New Zealand, UK,
- A generic version of Keppra-XR is available in India.
Branded Generic Names5 & Transcribed or Transliterated INN/Generic Name6
- Kevtam: Australia
- Kepcet: Australia
- Kopodex: Chile
- levetirasetaamille: Finland
- Levitam: Australia
- 左乙拉西坦: China
- 레비티라세탐 (rebitirasetam): Korea
Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.
Specific generics with complaints, or preferred generics manufacturers
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.
Generics with independently-tested bioequivalence
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):
Oral solution: 100 mg/mL is clear, colorless, grape-flavored and is supplied in 16 ounce bottles
- 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.
Intravenous injection: 500 mg/5 mL is clear, colorless, sterile solution in single use 5 mL vials.
Tablets: 3 years. Oral solution: 3 years (7 months after opening). IV Injection: 2 years.
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Please rate Keppra (levetiracetam): a review of the literature and consumer experience.
Everybody hates me.
- Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
- Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
- Keppra’s Full US Prescribing Information
- Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
- Article I, Section 8 of the US Constitution
- Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
- History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014
1 "Idiopathic" is doctorese for: The odds are you were born with it, but the symptoms didn't pop up until recently, so your doctor isn't 100% sure about what's causing the problem, but somehow it's your fault.
2 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, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as 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.
3 See the footnote above.
4 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.
5 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.
6 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.
If you have any questions not answered here, please see the Crazymeds Keppra discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us
|Last modified on Thursday, 26 September, 2013 at 10:24:47 by JerodPoore||Page Authors , Jerod Poore||Date created Tuesday, 04 October 2011 at 11:12:28|
|“Keppra Comprehensive Rundown Part 1″ by is copyright © 2011 ||Published online 2011/10/04|
Keppra, and all other drug names on this page and used throughout the site, are a trademark of someone else.
will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
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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 something along the lines of 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. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
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. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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.
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.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!
‘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? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
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