Keppra (Levetiracetam) 250 mg / 500 mg / 750 mg / 1000 mg Tablets: Prescription Broad-Spectrum Antiepileptic for Partial-Onset, Myoclonic, and Tonic-Clonic Seizures — SV2A Ligand, Minimal Drug Interactions, Generic Available

Information last reviewed: May 2026 — for educational purposes only.

What Is Keppra (Levetiracetam)?

Levetiracetam, branded as Keppra, is a second-generation broad-spectrum antiepileptic drug (AED). Unlike older AEDs, its mechanism is unique: binding to synaptic vesicle protein SV2A, modulating neurotransmitter release. It does not bind sodium channels, GABA receptors, or calcium channels in the traditional sense. This novel mechanism produces broad anticonvulsant activity with a favourable tolerability and drug-interaction profile. It undergoes predominantly renal excretion, avoids hepatic CYP metabolism, and does not affect the metabolism of other AEDs — making it an excellent adjunct. Available as tablets, XR tablets, oral solution (100 mg/mL), and IV formulation.

Prescription (Rx) Status

Levetiracetam is prescription-only. Its major limitation is behavioural side effects ("Keppra rage") — irritability, aggression, mood changes — particularly in paediatric patients. Pyridoxine (vitamin B6) supplementation is sometimes used to mitigate these. Dose reduction required in renal impairment (renally cleared). No routine serum level monitoring required.

Uses of Levetiracetam

FDA-approved adjunct for partial-onset seizures (adults and children ≥1 month), myoclonic seizures in juvenile myoclonic epilepsy, and primary generalised tonic-clonic seizures. Off-label: status epilepticus (IV), seizure prophylaxis after traumatic brain injury.

Tablet Strengths

Immediate-release tablets: 250 mg, 500 mg, 750 mg, and 1,000 mg. Extended-release tablets (Keppra XR): 500 mg and 750 mg. Starting dose: 500 mg twice daily. Target dose: 1,000–3,000 mg/day in two divided doses. XR: 1,000–3,000 mg once daily. Renal-dose adjustment required for CrCl <80 mL/min.

Price

Generic levetiracetam is very affordable (~$15–$40/month). It is among the most cost-effective modern AEDs.

Frequently Asked Questions

Q: What is "Keppra rage"?
A: A colloquial term for the behavioural side effects of levetiracetam — irritability, aggression, mood swings, and emotional lability. Occurring in roughly 10–15% of patients, it is more common in children and those with prior psychiatric conditions. B6 supplementation and dose adjustment may help; in severe cases, switching AEDs is considered.

Q: Does levetiracetam require blood level monitoring?
A: Routine monitoring is not required, unlike older AEDs. Dose titration is guided by clinical response and tolerability. Renal function should be checked periodically to adjust dosing.

Q: Is Keppra safe during pregnancy?
A: Levetiracetam has a comparatively lower teratogenic risk than older AEDs such as valproate or phenytoin, and is preferred for some women of childbearing potential. However, no AED is without risk in pregnancy; decisions should be made with a neurologist and obstetrician.

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