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Levetiracetam side effects and how to avoid them

Levetiracetam serious side effects include hallucinations and suicide. Learn how to minimize or avoid levetiracetam side effects.
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By | Sep. 27, 2022 Medically reviewed by Karen Berger, Pharm.D.
Rx pill bottle and prescription pad: Levetiracetam side effects and how to avoid them

Key takeaways

  • Levetiracetam is a generic prescription drug used alone or with other medicine(s) to control seizures. Common side effects include sleepiness and weakness, and serious side effects may include depression and hallucinations.

  • It can cause psychiatric issues such as hallucinations and thoughts of suicide in a small percentage of patients. These and other serious side effects require immediate medical attention.

  • Side effects can start early in treatment but most serious effects (and even some mild ones) like infections and weakness tend to take at least a few weeks to appear.

  • To minimize side effects, it’s important to provide a full medical history to the prescriber, take levetiracetam as prescribed, avoid alcohol, and consult healthcare providers for managing symptoms.

Common levetiracetam side effects | Serious side effects | Hallucinations | Suicide | Side effects timeline | Contraindications | Warnings | Interactions | How to avoid side effects | How to treat side effects

Levetiracetam is a generic prescription drug used alone or with other drugs to control seizures. There are several types of seizures, and individual anticonvulsants are approved to treat some but usually not all of them. Levetiracetam and its brand-name versions, Keppra and Keppra XR (which contains an extended-release form of levetiracetam), are only approved to treat partial onset seizures (seizures that do not affect awareness), generalized tonic-clonic seizures (loss of consciousness and convulsions), and juvenile myoclonic epilepsy (myoclonic seizures or muscle jerks). 

Levetiracetam is chemically different from other anticonvulsants. The overall effect is to decrease chemicals in the brain that pass signals between nerves, making it less likely for nerves to fire uncontrollably. Most people are prescribed immediate-release or extended-release levetiracetam tablets, but those unable to take tablets will be given an oral solution or IV injections. The most commonly-experienced side effects are neurological and behavioral.

Common side effects of levetiracetam

Side effects will depend on the type of seizure being treated and the dosage format used. In general, the most common side effects are sleepiness and weakness. Common side effects of levetiracetam include:

  • Sleepiness
  • Weakness
  • Fatigue
  • Headache
  • Infection
  • Nausea and vomiting
  • Aggression
  • Dizziness
  • Sore throat
  • Loss of appetite
  • Abnormal behavior/mood swings
  • Pain
  • Cough
  • Depression
  • Agitation
  • Nervousness
  • Irritability
  • Diarrhea
  • Nasal congestion
  • Constipation
  • Altered mood
  • Insomnia
  • Coordination problems

Serious side effects of levetiracetam

Serious side effects of levetiracetam include:

  • Depression
  • Hallucinations
  • Psychosis
  • Suicidal thoughts
  • Kidney problems
  • Kidney failure
  • Muscle damage
  • Blood disorders
  • Withdrawal seizures (if the drug is abruptly stopped)
  • Severe allergic or skin reactions

Levetiracetam and hallucinations

Approximately 1 out of every 100 people taking levetiracetam will experience serious psychiatric problems such as hallucinations, psychosis, and thoughts of suicide. Hallucinations and psychosis can happen early in treatment but may get better over time. The healthcare provider may reduce the dose to see if that helps. A pyridoxine (vitamin B6) supplement may also help reduce psychiatric side effects. The healthcare provider can recommend a dose of pyridoxine.

Levetiracetam and suicide

Thoughts about suicide, suicidal behaviors, or suicide attempts occur in as many as 1 in 200 people taking levetiracetam. Unlike certain antidepressants that can sometimes increase the risk of suicidal thoughts and behavior in children and young adults, suicide risk associated with levetiracetam (or other antiepileptic drugs) isn’t higher in children and young adults. Instead, risk factors include a history of mental health disorders, substance abuse, or brain injury. Family and caregivers should monitor for signs of suicidality and changes in mood and behavior in patients who take levetiracetam, especially if any of these risk factors are present. Any sign of suicidality should be reported immediately to the prescribing healthcare provider.

How soon do levetiracetam side effects start?

Many mild to moderate side effects can occur early in treatment including vomiting, diarrhea, and behavior or mood changes. Some allergic reactions could happen after the first dose, but serious drug or skin reactions may take a few weeks of daily dosing before symptoms appear. Most serious side effects (as well as many mild side effects) such as weakness, infections, blood disorders, and suicidal thoughts are delayed. It will usually take a few weeks, or even longer, for these to become a problem.

How long do levetiracetam side effects last?

Many mild side effects may improve over time, but some, such as infections, may continue to occur and re-occur over the course of treatment. Most side effects will improve when the drug is discontinued. Levetiracetam should not be stopped abruptly. When it’s time to stop taking levetiracetam, a healthcare provider will prescribe a steadily tapering dose. Side effects will improve as the dose decreases and should resolve about a few days after the last dose is taken.

What are the long-term side effects of levetiracetam?

Levetiracetam is used for months and years to control seizures. As long it’s working, and the side effects are manageable, there’s no reason to stop taking it. Consult your healthcare professional for more information on long-term use of levetiracetam. 

Levetiracetam contraindications

Anyone who has had a hypersensitivity reaction to levetiracetam can never take the drug again. Otherwise, there are no other medical conditions that will prevent healthcare providers from prescribing levetiracetam.

Pregnancy

Healthcare professionals are cautious about using levetiracetam during pregnancy. On the one hand, animal studies have shown levetiracetam can cause significant fetal harm. On other hand, 20 years of using the drug on pregnant women have produced no evidence of fetal harm or other problems. One significant issue, though, is that pregnant women eliminate levetiracetam from the body faster than nonpregnant women, so doses may need to be increased. Women who are pregnant or planning to become pregnant should consult their healthcare provider. 

Breastfeeding

Levetiracetam is excreted in human breast milk; these levels can be high in some women and low in others. Nursing infants on average get about 8% of the mother’s dose adjusted for weight differences. The healthcare provider will weigh the risks and benefits of using levetiracetam during breastfeeding. In nursing women who take levetiracetam, the baby will be monitored for drowsiness, weight gain, and milestones. 

Children

The Food and Drug Administration (FDA) has approved levetiracetam in children as young as 1 month old for partial-onset seizures. Levetiracetam is also approved for myoclonic seizures in adolescents 12 years and older with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in children and adolescents 6 years and older with generalized epilepsy. However, very young children—4 years of age or younger—are at an increased risk of high blood pressure, so they will need to be monitored.

Older adults

In clinical trials, the safety and effectiveness of levetiracetam were the same in people ages 65 years and older as it was in younger adults. However, decreased kidney function may increase the risk for side effects. Most of the drug is eliminated from the body by the kidneys. When prescribing levetiracetam to adults ages 65 years or older, healthcare providers will generally start the patient at a lower dose and monitor kidney function.

Levetiracetam warnings

Levetiracetam can cause problems in some people, including issues with pre-existing conditions.

Cautions

Because levetiracetam is primarily removed from the body by the kidneys, people with kidney disease may accumulate higher concentrations of the drug in their blood. This increases the likelihood of side effects, so healthcare professionals may reduce the dose and monitor side effects more closely.

Levetiracetam is more likely to cause hallucinations and psychosis in people with a history of one or more psychiatric disorders. 

Dependence and withdrawal

While levetiracetam does not cause physical dependence, stopping levetiracetam all at once may increase the incidence of seizures. In some cases, the abrupt discontinuation of levetiracetam can be followed by long, severe seizures called status epilepticus. Except in cases of severe reactions, levetiracetam will be prescribed in steadily decreasing doses when it’s time to quit. This helps prevent withdrawal seizures. 

Abuse 

Levetiracetam is not considered a risk for drug abuse or misuse. 

Overdose

Your healthcare provider will select the appropriate dosage for you. Do not take more or less than prescribed. Seek emergency medical attention or call a poison control center at 1-800-222-1222 if an overdose of levetiracetam is taken. The most common symptom of an overdose is somnolence, or excess sleepiness. Other symptoms might include hostility, agitation, slight loss of consciousness, slow and shallow breathing, and coma. 

Levetiracetam interactions

Before taking levetiracetam, tell your healthcare provider about all of the medications you take, including prescription and OTC drugs, vitamins, and supplements. 

  • Some drugs are never prescribed to people with seizure disorders including the antidepressant bupropion, the muscle weakness medications Firdapse (amifampridine) and Ampyra (dalfampridine), and metoclopramide, a drug that helps people whose stomachs empty too slowly. It’s not that these drugs interact with levetiracetam, it’s that they can increase the risk of seizures in people with epilepsy.
  • Because levetiracetam has sedative properties, sleepiness, tiredness, and dizziness are common side effects. These problems can be worsened by combining levetiracetam with similar central nervous system depressants such as opioids, benzodiazepines, barbiturates, sleep aid medications, antihistamines, muscle relaxers, marijuana, and alcohol. 

How to avoid levetiracetam side effects

Many people tolerate levetiracetam well with minimal side effects. However, side effects can still occur. A few tips can help minimize or even prevent problems.

1. Make sure the prescriber has a complete medical history

Side effects can be prevented before the drug is even prescribed. All it takes is to make sure the prescriber has a complete medical history and is aware of certain medical conditions including:

  • Any history of depression, mood problems, suicidal thoughts, or suicide attempts
  • Kidney problems
  • Pregnancy or pregnancy plans
  • Breastfeeding or breastfeeding plans

Drug interactions are another source of possible side effects, but they aren’t as serious as they are for other anticonvulsants. Still, make sure the prescriber and the pharmacist filling the prescription know about all the prescription drugs, over-the-counter medications, and supplements being taken. They may have good advice on how to minimize drug interactions.

2. Take levetiracetam as prescribed

Taking too much levetiracetam makes side effects more likely. Make sure to follow the instructions carefully and take the medication exactly as prescribed. Don’t take too much and don’t take the drug too many times a day. If a dose is missed, take it as soon as possible. However, to avoid taking too much medicine, skip the missed dose if it’s almost time for the next dose. Just take the next dose as scheduled. Don’t take a double dose to make up for the missed dose. Always refill your prescription a few days early, so that you never run out of medication. 

3. Avoid drinking

Drinking alcohol can worsen certain side effects of levetiracetam, such as drowsiness, dizziness, and fatigue. Combining alcohol with levetiracetam can impair coordination and driving, and can even slow or stop breathing. Consult your healthcare provider to determine how much, if any, alcohol is safe for you to consume.

4. Avoid drugs and supplements that cause drowsiness

For the same reason, try to avoid drugs like sedating over-the-counter antihistamines (such as diphenhydramine). The same applies to supplements such as kava or valerian. Ask your pharmacist for a recommendation that will be safe with your medications. 

5. Avoid driving and other risky activities

To prevent injuries or accidents, avoid driving, operating machinery, or other risky activities in the first few days of treatment. This allows time to figure out how much the drug impairs focus and attention.

How to treat side effects of levetiracetam

Most mild side effects can be managed at home, but some side effects will require the help of a healthcare provider.

Drowsiness

When feeling drowsy, dizzy, or weak, sit or lie down. If driving, pull over and rest. This will prevent drowsiness or dizziness from evolving into something worse like falling, having an accident, or getting injured. If drowsiness, fatigue, or dizziness doesn’t improve over time, get medical advice from the prescriber.

Headache

Pain relievers such as acetaminophen, aspirin, or ibuprofen are okay to take, but make sure to talk to the prescriber first. Drinking fluids and resting can also help. If headaches are severe or go on for days at a time, talk to the prescriber.

Coordination problems

Problems with balance or changes in gait should be reported to the prescribing healthcare provider.

Mood changes

Aggression, irritation, agitation, and other mood changes should be reported to the prescribing healthcare provider.

Psychosis

Immediately report hallucinations, delusions, or incoherent talk to the prescribing healthcare provider, especially if there’s a history of mental health issues. These may be caused by the drug. The prescriber may either reduce the dose, recommend vitamin B6 supplements, or switch to another medicine.

Suicidal thoughts

It’s important for both caregivers and patients to watch for any sign of suicidality and immediately talk to the prescribing healthcare provider. These include worsening depression, mood changes, unusual behaviors, and talking about suicide or death. 

Allergic reactions

An allergic reaction or skin reaction when taking this drug will require immediate medical help. These reactions are life-threatening and may cause death if not treated. Do not take another dose. Seek emergency medical help right away.

  • Symptoms of an allergic reaction include hives, swelling of the face, throat, or mouth as well as difficulty swallowing or trouble breathing. A severe adverse reaction could also include lightheadedness, fainting, racing heartbeats, confusion, and even passing out. 
  • A potentially life-threatening skin reaction usually starts with flulike symptoms such as fever and sore throat, then develops into a painful rash that spreads and blisters.

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