Levroxa (Levetiracetam)
Also sold as: Levroxa, Keppra, Levipil, Levecon, Levesam
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 250mg, 500mg, 750mg, 1000mg +2
Indications
- Partial (focal) seizures — adjunct and monotherapy
- Juvenile myoclonic epilepsy (JME) — first-line adjunct
- Primary generalised tonic-clonic seizures
- Absence seizures (adjunct)
- Status epilepticus (IV)
- Seizure prophylaxis (peri-operative neurosurgery)
Adult Dosing
Focal seizures / GTC
Start 500 mg PO BD; increase by 500 mg/week to 1000-3000 mg/day
Maintenance indefinite
Status epilepticus (IV)
60 mg/kg IV (max 4500 mg) over 10 minutes
Non-inferior to valproate for non-convulsive SE per ESETT trial
Pediatric Dosing
Oral solution (100mg/mL) for infants and young children. IV same weight-based dose as adults. TDM: 12-46 mg/L (not routinely required).
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 80 mL/min | 500-1500 mg BD |
| CrCl 50-80 mL/min | 500-1000 mg BD |
| CrCl 30-50 mL/min | 250-750 mg BD |
| CrCl < 30 mL/min | 250-500 mg BD |
| Hemodialysis | 500-1000 mg OD; supplemental dose 250-500 mg after each session |
Hepatic Adjustment
No adjustment required — primarily renally eliminated unchanged
Pregnancy & Lactation
Pregnancy: Category C
Preferred anticonvulsant in pregnancy over valproate and carbamazepine. Limited human data but animal studies show teratogenicity only at very high doses. Levels fall during pregnancy — monitor TDM. Use minimum effective dose.
Lactation: Caution
Excreted in breast milk in significant amounts. Monitor infant for sedation or poor feeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| No major pharmacokinetic interactions | Major advantage of levetiracetam — minimal drug-drug interactions (not CYP-metabolised) | Minor |
| CNS depressants / Alcohol | Additive CNS depression | Moderate |
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Side Effects
Common
- Somnolence (drowsiness)
- Dizziness
- Irritability / Mood changes (clinically important)
- Asthenia (fatigue)
- Headache
- Nasopharyngitis
Serious / Discontinue If
- Severe psychiatric symptoms (agitation, psychosis, suicidal ideation — especially in patients with prior psychiatric history)
- Leukopenia / thrombocytopenia (rare)
- SJS (very rare)
Contraindications
- Levetiracetam hypersensitivity
- Severe psychiatric disorder (relative — use with psychiatrist input)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Levipil 500mg | Sun Pharma | 10 tab ₹115 |
| Levroxa 500mg | Cipla | 10 tab ₹105 |
| Keppra 500mg | UCB | 10 tab ₹245 |
| Levecon 500mg | Intas | 10 tab ₹95 |
Monitoring Required
- Renal function (dose adjust based on CrCl)
- Mood and behaviour (psychiatric symptoms)
- CBC (blood dyscrasias — rare)
- Serum levetiracetam level if non-compliance or toxicity suspected (12-46 mg/L)
Patient Counseling Points
- Can be taken with or without food
- Report any significant mood changes, irritability, or thoughts of self-harm immediately
- Do NOT stop suddenly — seizure risk
- Renal function tests needed — dose is adjusted based on kidney function
- One of the safest anticonvulsants during pregnancy — but do NOT change medication without specialist advice
- Alcohol worsens drowsiness — avoid
Stop Googling drug references mid-consultation
EasyClinic auto-flags Levroxa interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Vikram Sinha, DM (Neurology), Senior Neurologist
Last reviewed: 2026-04-01
References
- BNF — Levetiracetam
- ILAE Epilepsy Guidelines
- ESETT Trial (Status Epilepticus)
- IAP Epilepsy Guidelines 2024