What patient education is necessary for those taking Keppra (levetiracetam) for seizure management, including the importance of not stopping the medication and the frequency of lab checks, such as complete blood counts, liver function tests, and renal function tests?

Patient Education for Keppra (Levetiracetam) and Laboratory Monitoring Guidelines

Importance of Not Stopping Keppra

Patients should never discontinue Keppra (levetiracetam) without consulting their healthcare provider, as abrupt discontinuation can lead to increased seizure frequency or breakthrough seizures. 1

Patient Education Points

• Inform patients to take Keppra exactly as prescribed and not to miss doses, as consistent blood levels are essential for seizure control 2
• Advise patients that Keppra may cause dizziness and somnolence, which could affect their ability to drive or operate machinery until they know how the medication affects them 2
• Educate patients about potential behavioral changes including aggression, agitation, anger, anxiety, depression, hostility, and irritability that may occur with Keppra therapy 2
• Instruct patients to report any unusual changes in mood, behavior, or thoughts of self-harm immediately to their healthcare provider 2
• Inform patients about common side effects including somnolence, fatigue, and headaches, which are usually mild to moderate 3
• Advise patients to carry medical identification indicating they have epilepsy and are taking antiepileptic medication 4
• Counsel female patients of childbearing potential to notify their physician if they become pregnant or intend to become pregnant during therapy 2
• Encourage pregnant patients to enroll in the North American Antiepileptic Drug (NAAED) pregnancy registry by calling 1-888-233-2334 2

Laboratory Monitoring Guidelines

Routine laboratory monitoring is not systematically required for patients on Keppra therapy unless there are specific risk factors present. 2

Initial Laboratory Testing

• Before starting Keppra, obtain baseline complete blood count, liver function tests, and renal function tests 2
• For patients with pre-existing renal impairment, baseline renal function testing is particularly important as Keppra is primarily excreted by the kidneys 2

Ongoing Laboratory Monitoring

• For most patients without risk factors, routine laboratory monitoring is not necessary during Keppra therapy 2
• For patients with pre-existing liver disease, consider monthly liver function tests 5
• For patients with renal impairment, regular monitoring of renal function is recommended as Keppra clearance is correlated with creatinine clearance 2
• For elderly patients (>65 years), consider more frequent renal function monitoring as clearance may be reduced by up to 38% compared to younger adults 2

Special Considerations

• Monitor complete blood count in patients who develop signs of infection, as minor decreases in white blood cell counts have been observed with Keppra treatment 2
• In pediatric patients, be aware that decreases in white blood cell and neutrophil counts may occur more frequently than in adults 2
• For patients with risk factors for kidney injury, monitor renal function periodically as there have been rare reports of acute kidney injury associated with levetiracetam 6

Dosing Considerations

• Standard adult dosing begins at 500 mg twice daily with potential increases to 1000-3000 mg/day based on clinical response 4
• Dose adjustments are necessary for patients with renal impairment:
  • For creatinine clearance 50-80 mL/min: 500-1000 mg every 12 hours
  • For creatinine clearance 30-50 mL/min: 250-750 mg every 12 hours
  • For creatinine clearance <30 mL/min: 250-500 mg every 12 hours 2
• Supplemental doses should be given to patients after hemodialysis as approximately 50% of levetiracetam is removed during a standard 4-hour hemodialysis procedure 2

Efficacy Monitoring

• Assess seizure frequency and severity regularly to determine treatment effectiveness 7
• Consider seizure diaries to track frequency and patterns of seizures 4
• Evaluate for adverse effects at each visit, particularly behavioral changes which may require dose adjustment 2

Remember that while generic levetiracetam is bioequivalent to brand name Keppra, some patients may experience breakthrough seizures when switching between formulations. If this occurs, consider returning to the previous effective formulation 1.