From the Guidelines
Keppra (levetiracetam) requires monitoring, though less intensive than some other antiepileptic medications, with a focus on periodic monitoring of complete blood count, liver function, and kidney function, as well as behavioral changes and mood disturbances. Patients taking Keppra should have baseline blood tests before starting treatment, especially in those with pre-existing renal impairment 1. Unlike other antiepileptic drugs, Keppra doesn't require regular blood level monitoring in most cases because it has a wide therapeutic range and fewer drug interactions. However, healthcare providers should monitor patients for behavioral changes, mood disturbances, and suicidal thoughts, as Keppra can cause psychiatric side effects including irritability, aggression, depression, and anxiety (sometimes called "Keppra rage") 1. Patients should report any unusual mood changes, excessive sedation, or coordination problems. Those with kidney disease may need dose adjustments based on their creatinine clearance. Regular follow-up appointments are important to assess seizure control, medication adherence, and any adverse effects, typically every 3-6 months for stable patients or more frequently when starting treatment or adjusting dosage.
Some key points to consider when monitoring Keppra include:
- Baseline blood tests before starting treatment
- Periodic monitoring of complete blood count, liver function, and kidney function
- Monitoring for behavioral changes, mood disturbances, and suicidal thoughts
- Dose adjustments for patients with kidney disease based on creatinine clearance
- Regular follow-up appointments to assess seizure control, medication adherence, and adverse effects.
It's worth noting that the most recent study 1 from 2024 provides updated guidance on the management of adult patients presenting to the emergency department with seizures, but the specific monitoring requirements for Keppra are not significantly changed from previous recommendations.
From the FDA Drug Label
Although most laboratory tests are not systematically altered with levetiracetam treatment, there have been relatively infrequent abnormalities seen in hematologic parameters and liver function tests. Laboratory Tests Although most laboratory tests are not systematically altered with levetiracetam treatment, there have been relatively infrequent abnormalities seen in hematologic parameters and liver function tests.
Monitoring is required for patients taking levetiracetam due to the potential for abnormalities in hematologic parameters and liver function tests.
- Hematologic parameters and liver function tests should be monitored. 2
From the Research
Monitoring of Keppra
- Keppra, also known as levetiracetam, is an antiepileptic drug that requires monitoring due to its potential for adverse effects and interactions with other medications 3, 4.
- The therapeutic range of levetiracetam is 20-40mg/L, and monitoring of drug levels is necessary to ensure efficacy and minimize toxicity 4.
- Studies have shown that levetiracetam can cause asymptomatic elevation of liver enzymes, which requires monitoring of liver function tests 3.
- In critically ill patients, the pharmacokinetics of levetiracetam are altered, and higher doses may be required to achieve target levels 5.
- Monitoring of levetiracetam levels is also necessary in patients taking other antiepileptic medications, as interactions can occur and affect seizure control 4.
Adverse Effects and Interactions
- Levetiracetam can cause adverse effects such as somnolence, dizziness, and elevated liver enzymes 3, 6.
- Interactions with other antiepileptic medications, such as carbamazepine, valproate, and lamotrigine, can occur and affect levetiracetam levels and seizure control 4.
- Monitoring of adverse effects and interactions is necessary to ensure safe and effective use of levetiracetam.
Patient Populations
- Levetiracetam can be used in various patient populations, including those with traumatic brain injury, intracerebral hemorrhage, and supratentorial neurosurgery 7.
- In patients aged 65 years and older, levetiracetam was found to be effective and well-tolerated as add-on therapy for partial-onset seizures 6.
- In critically ill neurosurgical patients, higher doses of levetiracetam may be required to achieve target levels due to altered pharmacokinetics 5.