Keppra, the brand name for the antiepileptic drug levetiracetam, is a widely prescribed medication for controlling various types of seizures in both adults and children. While effective, it is associated with a range of side effects. The most frequently reported adverse effects are rooted in its impact on the central nervous system, affecting wakefulness and energy levels. This article explores these common effects, strategies for managing them, and a comparison with other antiepileptic drugs.
The Most Frequent Side Effects: Drowsiness and Weakness
In controlled clinical trials involving adults with partial-onset seizures, somnolence and asthenia were reported by 15% of patients taking Keppra, compared to 8% and 9% of placebo patients, respectively. These effects are most common during the first month of treatment and tend to subside as the patient's body adapts to the medication.
- Somnolence (Drowsiness): This side effect can manifest as feeling unusually tired or sleepy during the day. It can be worsened by alcohol consumption or by taking other medications that also cause drowsiness. Patients are advised to avoid activities requiring high alertness, such as driving, until they understand how the medication affects them.
- Asthenia (Weakness or Fatigue): Patients may feel unusually weak or fatigued, which can interfere with daily activities. This side effect also tends to be most prominent in the early stages of therapy.
Other Common Adverse Effects
Beyond drowsiness and weakness, Keppra can cause a variety of other common side effects, which may differ slightly between adults and children.
Central Nervous System (CNS) Effects
- Dizziness: Occurring in 9% of adults and 7% of children in controlled studies, dizziness can be a notable adverse effect. Patients should be cautious with activities that require balance until they know how Keppra affects them.
- Headache: Reported by 14% of adults in clinical trials, headaches are another common complaint. This can sometimes be managed with over-the-counter pain relievers.
- Behavioral and Mood Changes: This is a particularly noteworthy category of side effects, especially in children, who report mood-related issues like irritability, aggression, and fatigue more frequently than adults. In pediatric trials (ages 4-16), 38% of Keppra-treated patients experienced non-psychotic behavioral symptoms, compared to 19% of placebo patients. Adults may also experience anxiety, depression, and hostility. Severe cases of these behavioral changes have been termed "Keppra rage" by some patients.
Infections
Keppra may increase the risk of infections, especially upper respiratory tract infections. In clinical trials, infections were reported by 13% of adults and 15% of children. Common symptoms include nasal congestion, sore throat, and cough.
Gastrointestinal (GI) Effects
- Nausea and Decreased Appetite: Some patients experience nausea, which can sometimes be alleviated by taking Keppra with food. Decreased appetite is also a common complaint, especially in children.
Comparison of Adverse Effects: Keppra vs. Other AEDs
Different anticonvulsant drugs have different side effect profiles. Comparing Keppra to other common medications can help patients and doctors make informed decisions. Below is a comparison with lamotrigine (Lamictal) and divalproex (Depakote), based on reported side effects from clinical studies.
| Feature | Keppra (levetiracetam) | Lamotrigine (Lamictal) | Divalproex (Depakote) |
|---|---|---|---|
| Drug Class | Pyrrolidine anticonvulsant | Triazine anticonvulsant | Carboxylic acid anticonvulsant |
| Most Frequent CNS Effects | Drowsiness, weakness, dizziness, irritability, aggression | Headache, dizziness, insomnia, anxiety | Drowsiness, dizziness |
| Other Common Side Effects | Infection, nasal congestion, nausea | Rash, nausea | Stomach pain, hair loss, diarrhea |
| Key Serious Risks | DRESS syndrome, Stevens-Johnson syndrome, suicidal ideation | Severe rash (SJS/TEN), meningitis, suicidal ideation | Liver problems, pancreatitis, birth defects |
| Initial Onset of Side Effects | Many side effects, especially drowsiness and weakness, often occur within the first 4 weeks. | Side effects can be delayed; rash risk is higher in initial titration. | Can be managed by starting at a low dose. |
Managing Keppra's Adverse Effects
If you experience bothersome side effects while taking Keppra, it's crucial to discuss them with your healthcare provider. Never stop taking Keppra suddenly without medical guidance, as this can trigger a dangerous increase in seizure frequency.
- For Somnolence and Fatigue: These side effects often improve within the first month. Taking your dose with food or adjusting the timing can sometimes help. If persistent, your doctor may adjust your dosage or switch medications.
- For Behavioral Changes: It is important for patients and caregivers to monitor for signs of mood changes, anxiety, or aggression. A vitamin B6 supplement might sometimes be recommended by a healthcare provider, and dose adjustments may be necessary.
- For Dizziness: Avoid driving or operating heavy machinery until you are certain how the medication affects your coordination. If you feel dizzy, sit or lie down to prevent falls.
- For Gastrointestinal Issues: Taking Keppra with a meal or small snack can help reduce nausea.
Serious but Less Frequent Adverse Effects
While the risk is low, it is vital to be aware of potentially severe side effects associated with Keppra. Immediate medical attention is required if any of these symptoms appear.
- Suicidal Thoughts or Behavior: Like all antiepileptic drugs (AEDs), Keppra carries a warning about an increased risk of suicidal thoughts and behavior. Patients with a history of mental health conditions may be at higher risk and should be monitored closely by a doctor and family members.
- Severe Skin Reactions (SJS, TEN, and DRESS): The FDA has issued warnings regarding rare but serious skin reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Symptoms can include fever, rash, and swelling, and can be life-threatening.
- Blood Disorders: Keppra can cause abnormalities in blood cell counts, including decreases in white and red blood cells. A full blood count may be recommended if symptoms like unexplained weakness, fever, or unusual bruising occur.
Conclusion
While effective for controlling seizures, Keppra is associated with adverse effects, with drowsiness and weakness being the most frequently reported, especially during the initial stages of treatment. Other common side effects include dizziness, infections, and mood changes, which are more prevalent in children. Most mild side effects often resolve with continued use as the body adjusts, but monitoring for behavioral changes is important for all patients. It is essential to communicate openly with your healthcare provider to manage side effects effectively and to be aware of the signs of more serious, albeit rare, reactions. As with any AED, treatment discontinuation must be done gradually under a doctor's supervision to prevent an increase in seizure frequency. For more information, patients can consult the comprehensive resources available from sources such as the Epilepsy Foundation.
