Can you take diazepam with levetiracetam?

October 8, 2025 •

2 min read

In the United States, roughly half of all patients with epilepsy are on a regimen of five or more medications, a practice known as polypharmacy. This raises important questions about drug safety, such as 'Can you take diazepam with levetiracetam?'

Quick Summary

Taking diazepam and levetiracetam together is possible but requires strict medical supervision due to a heightened risk of central nervous system depression. This combination can lead to increased drowsiness, dizziness, and impaired coordination.

Key Points

Medical Supervision is Essential: Taking diazepam with levetiracetam should only be done under a doctor's guidance due to significant interaction risks.
Increased CNS Depression: The primary interaction is an additive central nervous system depressant effect, increasing drowsiness, dizziness, and confusion.
Different Primary Uses: Diazepam is often a fast-acting rescue medication for acute seizures or anxiety, while levetiracetam is a daily maintenance drug for epilepsy control.
Risk of Impaired Alertness: The combination can impair coordination and alertness, making activities like driving dangerous.
Avoid Alcohol: Consuming alcohol with this combination significantly worsens side effects like dizziness and drowsiness.
Clinical Use in Status Epilepticus: They are sometimes used together in a hospital setting to manage severe, prolonged seizures.
Dosage Adjustments May Be Needed: A doctor may need to adjust the dosage of one or both medications to ensure safety and efficacy.

Understanding Diazepam and Levetiracetam

Diazepam (Valium) is a benzodiazepine used for anxiety, muscle spasms, alcohol withdrawal, and some seizures. It calms the brain by increasing the effect of GABA. Levetiracetam (Keppra) is an anti-epileptic drug for various seizures. It is thought to work by binding to the SV2A protein in the brain.

Co-administration: Is It Safe?

Taking diazepam and levetiracetam together is possible but only under strict medical supervision. This combination may be used in hospital settings for severe seizures like status epilepticus. One study showed early levetiracetam after intravenous diazepam was effective for seizures, including those resistant to diazepam alone, without major side effects.

However, both drugs are CNS depressants, slowing brain activity. Taking them together can increase the risk of side effects due to additive effects.

The Primary Interaction: Increased CNS Depression

The main interaction between diazepam and levetiracetam is the potential for increased CNS and respiratory depression. Both can cause drowsiness, dizziness, and concentration issues. Combined, these effects can be more severe.

Potential Side Effects of the Combination

Close monitoring for increased side effects is necessary for patients taking both medications:

Excessive Drowsiness: The most common effect, which can make activities requiring alertness, like driving, dangerous.
Dizziness and Impaired Coordination: This can affect balance and motor skills, increasing the risk of falls.
Confusion: Cognitive function can be impaired.
Respiratory Depression: Slowed breathing is a potential, life-threatening risk with multiple CNS depressants.

A doctor may adjust dosages and monitor for adverse effects. Alcohol should be avoided as it worsens CNS depressant effects.

Comparison of Diazepam and Levetiracetam


Feature	Diazepam (Valium)	Levetiracetam (Keppra)
Drug Class	Benzodiazepine	Anticonvulsant / Anti-epileptic
Primary Use	Anxiety, muscle spasms, alcohol withdrawal, acute seizures	Long-term management of various types of epilepsy
Mechanism	Enhances the effect of GABA, an inhibitory neurotransmitter	Binds to synaptic vesicle protein SV2A, modulating neurotransmitter release
Common Side Effects	Drowsiness, dizziness, fatigue, muscle weakness	Sleepiness, dizziness, fatigue, aggression, mood changes
Onset of Action	Rapid (IV: 1-3 mins; Oral: 15-60 mins)	Rapid absorption, steady-state achieved in two days
Role in Seizure Treatment	Often used as a 'rescue' medication for acute or cluster seizures	Used as a daily maintenance medication to prevent seizures

When Might a Doctor Prescribe Both?

This combination is sometimes used for status epilepticus, a prolonged seizure medical emergency. Fast-acting intravenous diazepam stops the seizure, and levetiracetam is then used to prevent more seizures.

Another scenario is a patient on levetiracetam for seizures who needs short-term diazepam for severe anxiety or muscle spasms. The doctor will weigh benefits against risks.

Conclusion

Combining diazepam and levetiracetam requires strict medical supervision due to the risk of increased CNS depression, leading to drowsiness, dizziness, and impaired coordination. Patients should avoid activities requiring mental alertness until they know how the drugs affect them and must avoid alcohol. Open communication with a healthcare provider is vital for safe and effective use.

For more information on drug interactions, you can consult resources like the FDA's official website.

Frequently Asked Questions

The main risk is an increased central nervous system (CNS) depressant effect, which can lead to excessive drowsiness, dizziness, confusion, and impaired coordination.

No, you should avoid or limit the use of alcohol. Alcohol can increase the nervous system side effects of both medications, such as dizziness and drowsiness.

No, oral diazepam is typically used for short-term management of anxiety or as an adjunctive therapy for certain seizure disorders, but it is not a first-choice for long-term control. Levetiracetam is a standard maintenance medication for epilepsy.

The most common brand name for diazepam is Valium, and for its rectal gel form, Diastat. Levetiracetam is most commonly known by the brand name Keppra.

A doctor might prescribe both in an emergency setting, like for status epilepticus, where fast-acting diazepam is used to stop a seizure and levetiracetam is used to prevent recurrence. It might also be used if a patient on levetiracetam needs short-term treatment for a condition like severe anxiety.

If you experience excessive drowsiness, confusion, or trouble concentrating, you should notify your doctor. You should also avoid hazardous activities like driving until you know how these agents affect you.

No, they have different mechanisms of action. Diazepam enhances the effects of the inhibitory neurotransmitter GABA. Levetiracetam's exact mechanism is unknown but involves binding to a specific protein (SV2A) to help calm brain activity.