Formulary
Levetiracetam: Indications, Dosing, Side Effects and Interactions
Levetiracetam clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Levetiracetam: Indications, Dosing, Side Effects and Interactions
Levetiracetam clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Monotherapy of focal seizures with or without secondary generalisation**
- **Child** (By Mouth, Or By Intravenous Infusion): 16-17 years Initially 250 mg once daily for 1 week, then increased to 250 mg twice daily, dose then increased in steps of 250 mg twice daily every 2 weeks up to maximum 1.5 g twice daily, to be adjusted according to response.
- **Adult** (By Mouth, Or By Intravenous Infusion): Initially 250 mg once daily for 1-2 weeks, then increased to 250 mg twice daily, dose then increased in steps of 250 mg twice daily every 2 weeks up to maximum 1.5 g twice daily, to be adjusted according to response.
**Adjunctive therapy of focal seizures with or without secondary generalisation**
- **Child** (By Mouth): 12-17 years (body-weight 50 kg and above) Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2-4 weeks up to maximum 1.5 g twice daily.
- **Adult** (By Mouth): Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2-4 weeks up to maximum 1.5 g twice daily.
- **Child** (By Intravenous Infusion): 12-17 years (body-weight 50 kg and above) Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2 weeks up to maximum 1.5 g twice daily.
- **Adult** (By Intravenous Infusion): Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2-4 weeks up to maximum 1.5 g twice daily.
**Adjunctive therapy of myoclonic seizures and tonic-clonic seizures**
- **Child** (By Mouth, Or By Intravenous Infusion): 12-17 years (body-weight 50 kg and above) Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2 weeks up to maximum 1.5 g twice daily.
- **Adult** (By Mouth, Or By Intravenous Infusion): Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2-4 weeks up to maximum 1.5 g twice daily.
**Convulsive status epilepticus (administered on expert advice)**
- **Child** (By Intravenous Infusion): 40 mg/kg for 1 dose (max. per dose 3 g), consult local protocols.
**Monotherapy of focal seizures with or without secondary generalisation for levetiracetam**
- **Child 16-17 years** (By mouth, or by intravenous infusion): Initially 250 mg once daily for 1 week, then increased to 250 mg twice daily, dose then increased in steps of 250 mg twice daily every 2 weeks up to maximum 1.5 g twice daily, to be adjusted according to response.
**Adjunctive therapy of focal seizures with or without secondary generalisation for levetiracetam**
- **Child 1-5 months** (By mouth): Initially 7 mg/kg once daily, dose then increased in steps of up to 7 mg/kg twice daily every 2 weeks up to maximum 21 mg/kg twice daily.
- **Child 6 months-17 years (body-weight up to 50 kg)** (By mouth): Initially 10 mg/kg once daily, dose then increased in steps of up to 10 mg/kg twice daily every 2 weeks up to maximum 30 mg/kg twice daily.
- **Child 12-17 years (body-weight 50 kg and above)** (By mouth): Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2-4 weeks up to maximum 1.5 g twice daily.
- **Child 4-17 years (body-weight up to 50 kg)** (By intravenous infusion): Initially 10 mg/kg once daily, dose then increased in steps of up to 10 mg/kg twice daily every 2 weeks up to maximum 30 mg/kg twice daily.
- **Child 12-17 years (body-weight 50 kg and above)** (By intravenous infusion): Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2 weeks up to maximum 1.5 g twice daily.
**Adjunctive therapy of myoclonic seizures and tonic-clonic seizures for levetiracetam**
- **Child 12-17 years (body-weight up to 50 kg)** (By mouth, or by intravenous infusion): Initially 10 mg/kg once daily, dose then increased in steps of up to 10 mg/kg twice daily every 2 weeks up to maximum 30 mg/kg twice daily.
- **Child 12-17 years (body-weight 50 kg and above)** (By mouth, or by intravenous infusion): Initially 250 mg twice daily, dose then increased in steps of 500 mg twice daily every 2 weeks up to maximum 1.5 g twice daily.
**Convulsive status epilepticus (administered on expert advice) for levetiracetam**
- **Child** (By intravenous infusion): 40 mg/kg for 1 dose (max. per dose 3 g), consult local protocols.
Cautions
Risk factors for QT interval prolongation
Side effects
Common or very common Anxiety; appetite decreased; asthenia; behaviour abnormal; cough; depression; diarrhoea; dizziness; drowsiness; gastrointestinal discomfort; headache; increased risk of infection; insomnia; mood altered; movement disorders; nausea; skin reactions; tremor; vertigo; vomiting Uncommon Alopecia; concentration impaired; confusion; hallucination; leucopenia; memory impairment; muscle weakness; myalgia; paraesthesia; psychotic disorder; suicidal behaviours; thrombocytopenia; vision disorders; weight changes Rare or very rare Acute kidney injury; agranulocytosis; bone marrow disorders; delirium; encephalopathy; gait abnormal; hepatic disorders; hyponatraemia; neutropenia; pancreatitis; personality disorder; QT interval prolongation; rhabdomyolysis; seizures exacerbated; severe cutaneous adverse reactions (SCARs); thinking abnormal Frequency not known Neuroleptic malignant syndrome (discontinue-potentially fatal)
Interactions
**Severe interactions:**
- As in adults, there is no evidence of clinically significant medicinal product interactions in paediatric patients receiving up to 60 mg/kg/day levetiracetam.
**Other interactions (10):**
- Antiepileptic medicinal products Pre-marketing data from clinical studies conducted in adults indicate that levetiracetam did not influence the serum concentrations of existing antiepileptic...
- A retrospective assessment of pharmacokinetic interactions in children and adolescents with epilepsy (4 to 17 years) confirmed that adjunctive therapy with orally administered levetiracetam did not...
- However, data suggested a 20 % higher levetiracetam clearance in children taking enzyme-inducing antiepileptic medicinal products.
- Probenecid Probenecid (500 mg four times daily), a renal tubular secretion blocking agent, has been shown to inhibit the renal clearance of the primary metabolite, but not of levetiracetam.
- Methotrexate Concomitant administration of levetiracetam and methotrexate has been reported to decrease methotrexate clearance, resulting in increased/prolonged blood methotrexate concentration to...
- Blood methotrexate and levetiracetam levels should be carefully monitored in patients treated concomitantly with the two drugs.
Pregnancy
Important safety information For levetiracetam MHRA/CHM advice: Antiepileptics: risk of suicidal thoughts and behaviour (August 2008) See Epilepsy . MHRA/CHM advice: Antiepileptic drugs: updated advice on switching between different manufacturers' products (November 2017) See Epilepsy . MHRA/CHM advice: Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review (January 2021) See Epilepsy .
Breast feeding
Present in milk-manufacturer advises avoid.
Hepatic impairment
Manufacturer advises caution in severe impairment. Dose adjustments Manufacturer advises maintenance dose reduction of 50% in severe impairment if creatinine clearance is less than 60 mL/minute/1.73 m 2 -consult product literature.
Renal impairment
Dose adjustments In children: Reduce dose if estimated glomerular filtration rate less than 80 mL/minute/1.73 m 2 (consult product literature). In adults: Maximum 2 g daily if eGFR 50-80 mL/minute/1.73 m 2 . Maximum 1.5 g daily if eGFR 30-50 mL/minute/1.73 m 2 . Maximum 1 g daily if eGFR less than 30 mL/minute/1.73 m 2 .
Medicinal forms
Solution,Tablet,Solution,Solution,Granules,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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