Can Keppra (Levetiracetam) cause bradycardia?

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Keppra Does Not Cause Bradycardia

Levetiracetam (Keppra) is not associated with bradycardia or heart rate reduction. This antiepileptic medication has a unique mechanism of action that does not affect cardiac conduction or heart rate control systems.

Mechanism and Cardiac Safety Profile

  • Levetiracetam works through binding to synaptic vesicle protein 2A and inhibiting N-type calcium channels in neuronal tissue, not cardiac tissue 1, 2.

  • Unlike medications that cause bradycardia through effects on the SA or AV nodes (such as beta-blockers or calcium channel blockers), levetiracetam has no direct effects on cardiac conduction systems 3, 4.

  • The drug lacks cytochrome P450 enzyme-inducing potential and does not have clinically significant pharmacokinetic interactions with cardiac medications 1, 2.

Clinical Evidence

  • In a study specifically evaluating cardiac effects in children with epilepsy, levetiracetam therapy actually showed positive contributions to cardiac repolarization parameters, with no bradycardia reported 5.

  • A safety study of rapid administration of high-dose IV levetiracetam (1500 mg) in 107 patients found only 2 cases (1.9%) of bradycardia, and one of these patients had pre-existing bradycardia before the dose 6.

  • In overdose cases with serum concentrations 10-40 fold higher than therapeutic levels, the primary effects were sedation and respiratory depression, not cardiac effects including bradycardia 7.

Common Adverse Effects of Levetiracetam

The actual side effect profile includes 8, 1, 2:

  • Fatigue and somnolence
  • Dizziness
  • Behavioral changes
  • Rarely, pain at IV infusion sites

Bradycardia is not listed among the recognized adverse effects of levetiracetam in clinical guidelines or research literature.

Clinical Pitfall to Avoid

If a patient on Keppra develops bradycardia, look for other causes 3:

  • Concurrent beta-blockers (metoprolol, atenolol, carvedilol)
  • Nondihydropyridine calcium channel blockers (diltiazem, verapamil)
  • Digoxin
  • Amiodarone or other antiarrhythmics
  • Underlying cardiac conduction disease

References

3
Guideline

Bradycardia Risk Associated with Various Medications

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

4
Guideline

Medication-Induced Bradycardia and Hypotension

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

7
Research

A case of levetiracetam (Keppra) poisoning with clinical and toxicokinetic data.

Journal of toxicology. Clinical toxicology, 2002

8
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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