Does levetiracetam cause diarrhea? Understanding the risk and management

October 9, 2025 •

4 min read

Clinical trial data indicates that levetiracetam can cause diarrhea, with studies showing it affects at least 1% of adult patients and up to 8% in certain patient groups. This gastrointestinal side effect, though often mild, is a known possibility for those starting or adjusting their medication.

Quick Summary

Levetiracetam is known to cause diarrhea in a small percentage of patients. Symptoms are generally mild and temporary, and can often be managed with simple dietary and hydration adjustments. Patients should always consult a healthcare provider for persistent or severe symptoms.

Key Points

Prevalence: Diarrhea is a known, but often mild, side effect of levetiracetam, affecting at least 1-8% of patients in clinical trials.
Management: Taking levetiracetam with food or a small snack can help reduce stomach upset and potentially mitigate diarrhea.
Hydration: It is important to increase fluid intake, such as water and electrolyte-rich drinks, to prevent dehydration when experiencing diarrhea.
Symptom Duration: For many, the side effect is temporary and subsides as the body adjusts to the medication, often within the first few weeks.
When to See a Doctor: Seek medical advice if diarrhea is severe, persistent, or accompanied by other serious symptoms like fever, stomach pain, or signs of dehydration.
Don't Stop Abruptly: Never stop taking levetiracetam without consulting a doctor, as doing so could worsen seizures.
GI Profile: Compared to some older antiepileptic drugs (AEDs), levetiracetam generally has a more favorable overall side effect profile, though individual GI reactions vary.

Levetiracetam, commonly known by its brand name Keppra, is an antiepileptic drug (AED) used to treat various types of seizures in both adults and children. While its efficacy is well-established, like all medications, it carries a risk of side effects. One such effect is gastrointestinal upset, with diarrhea being a documented, though typically mild, symptom for some users. It is important for patients and caregivers to understand the likelihood, causes, and effective management strategies for this issue.

The Connection Between Levetiracetam and Diarrhea

Diarrhea is a recognized adverse effect of levetiracetam, though its prevalence varies depending on the patient population and dosage. In clinical studies, at least 1% of adult patients and up to 8% of patients with primary generalized tonic-clonic seizures reported experiencing diarrhea. For most, this side effect is mild and tends to diminish over time as the body adjusts to the medication. However, it can sometimes be persistent or severe, requiring medical attention. Gastrointestinal issues often appear alongside other common side effects such as nausea, vomiting, loss of appetite, and stomach pain.

Potential Mechanisms for Gastrointestinal Upset

While levetiracetam's primary action is to bind to the synaptic vesicle protein 2A (SV2A) in the brain to regulate neurotransmitter release, the exact mechanism behind its gastrointestinal side effects is not fully understood. However, some contributing factors have been suggested:

Influence on Electrolyte Levels: Some research suggests that levetiracetam may cause shifts in certain electrolyte levels, such as hypokalemia and hypomagnesaemia, which could potentially impact normal bowel function.
Intestinal Inflammation: A very rare, older case report highlighted a possible link between levetiracetam and enterocolitis, a form of intestinal inflammation. However, this is not a typical presentation and most cases of diarrhea are not related to this serious complication.
Central Nervous System Effects: The drug's effects on the central nervous system may also indirectly influence the gastrointestinal tract, as the nervous system plays a critical role in regulating digestion.

Managing Diarrhea Caused by Levetiracetam

For most individuals, diarrhea can be managed at home with simple, self-care strategies. If the symptoms are mild and temporary, these measures can provide significant relief:

Take with Food: Taking levetiracetam with a small snack or meal can help settle the stomach and reduce gastrointestinal upset.
Stay Hydrated: Drink plenty of fluids like water, electrolyte-rich beverages, and broth to prevent dehydration, which is a key risk of diarrhea.
Eat Bland Foods: A bland diet, such as the BRAT diet (Bananas, Rice, Applesauce, Toast), can help firm up stools. Other easily digestible foods include white bread, plain pasta, and boiled chicken.
Avoid Trigger Foods: Temporarily avoid spicy, fried, or greasy foods, as well as those high in fiber, which can exacerbate symptoms.
Limit Alcohol: Alcohol can further irritate the gastrointestinal tract and should be limited or avoided while experiencing symptoms.
Use OTC Medications with Caution: Do not take over-the-counter anti-diarrheal medications without first speaking to a doctor or pharmacist, as they may not be appropriate for your situation.

Levetiracetam vs. Other Antiepileptic Drugs

Understanding how levetiracetam compares to other AEDs can provide important context regarding its gastrointestinal side effect profile. While individual reactions vary, certain trends have been observed.


Feature	Levetiracetam (Keppra)	Carbamazepine (Tegretol)	Sodium Valproate (Depakote)	Topiramate (Topamax)
Diarrhea Risk	Common (1-10%). Often mild and transient.	Can cause various GI side effects, including diarrhea.	Nausea and vomiting are more common GI side effects, can cause diarrhea less frequently.	Various GI symptoms possible; GI effects are not primary concern.
Overall GI Profile	Generally considered to have fewer serious GI reactions than older AEDs.	Associated with a higher risk of some GI issues when combined with other AEDs.	Can cause nausea and vomiting; weight gain is a known side effect.	Can cause appetite loss and GI upset.
Adjustment Period	Side effects like diarrhea and fatigue often improve within a few weeks as the body adjusts.	Often requires dose titration to minimize side effects.	Dose-dependent side effects may improve with time.	Dose titration is used to minimize side effects like cognitive slowing.

When to Contact a Doctor

While most cases of diarrhea related to levetiracetam are not serious, there are specific situations where medical advice is necessary. If you experience any of the following, contact your healthcare provider:

The diarrhea is severe, persistent, or worsens over time.
You develop signs of dehydration, such as dark urine, decreased urination, or excessive thirst.
Symptoms are accompanied by fever, severe abdominal pain, or blood in the stool.
You have new or worsening mental health changes, including irritability or anxiety.
You observe any other serious side effects, such as a rash, swelling, or signs of liver problems (yellowing skin or eyes).

Important: Do not abruptly stop taking levetiracetam, as this can increase the risk of seizures. Your doctor can help you safely taper the dosage or switch to an alternative medication if necessary. For more detailed information, consult authoritative sources like the FDA's medication guide for levetiracetam.

Conclusion

In summary, diarrhea is a potential, though usually manageable, side effect of levetiracetam. For many, it is a temporary issue that resolves as the body acclimates to the medication. By utilizing simple strategies such as taking the drug with food, staying hydrated, and eating a bland diet, most patients can effectively manage the symptoms. However, it is crucial to monitor symptoms and contact a healthcare professional if the diarrhea becomes severe, persistent, or is accompanied by other concerning signs. Open communication with your doctor is key to ensuring the medication is both effective and well-tolerated.

Frequently Asked Questions

Clinical studies have shown that at least 1% of adult patients and up to 8% of patients with primary generalized tonic-clonic seizures report diarrhea as a side effect.

The exact mechanism is not fully understood, but it is a known adverse effect. Potential contributing factors include minor electrolyte disturbances and indirect effects on the digestive system, although the drug's primary action is in the brain.

Yes, taking levetiracetam with a meal or snack can often help reduce the incidence and severity of gastrointestinal side effects like nausea and diarrhea.

For many, the diarrhea is a temporary side effect that occurs during the initial weeks of treatment as the body adapts to the medication. It often resolves on its own over time.

You should contact your doctor if the diarrhea is severe, doesn't go away, or is accompanied by other symptoms like fever, severe stomach pain, or signs of dehydration (e.g., dark urine).

It is best to consult with a pharmacist or doctor before taking any over-the-counter anti-diarrheal medications. They can ensure it is safe and appropriate to use with levetiracetam and your specific health condition.

Children taking levetiracetam can also experience diarrhea, along with other gastrointestinal issues like stomach pain and vomiting. The risk of some side effects can be higher in children, so it is important to monitor them closely and discuss any persistent issues with their doctor.