Can Liquid Levetiracetam (Keppra) Be Mixed with Pudding?
Yes, liquid levetiracetam can be safely mixed with pudding or other semisolid foods without significantly affecting its absorption or efficacy.
Evidence Supporting Food Mixing
A pharmacokinetic study demonstrated that crushing levetiracetam tablets and mixing with applesauce resulted in comparable absorption to intact tablets, with no significant differences in overall drug exposure (AUC values of 191.9 vs 165.7 μg/mL·h for intact vs applesauce-mixed formulations) 1
The same study showed that while peak concentrations (Cmax) were slightly reduced when mixed with food (14.8 vs 12.1 μg/mL), this difference was not statistically significant and did not affect the total amount of drug absorbed 1
Importantly, serum concentrations at 12 hours post-dosing were essentially identical across all administration methods (3.9-4.1 μg/mL), confirming that mixing with food does not impair the drug's therapeutic availability 1
Practical Administration Guidance
The liquid formulation can be mixed with pudding, applesauce, or similar semisolid foods immediately before administration to mask the taste, which is particularly useful in pediatric patients, elderly patients, or those with swallowing difficulties 1, 2
Administer the mixture immediately after preparation, as the long-term stability of levetiracetam mixed with food vehicles was not assessed in the available studies 1
The entire dose should be consumed to ensure complete medication delivery 1
Clinical Context
Levetiracetam has excellent oral bioavailability and rapid, complete absorption regardless of food intake, making it highly suitable for alternative administration methods 3, 2
The drug's favorable pharmacokinetic profile—including minimal protein binding, linear elimination kinetics, and lack of significant drug-drug interactions—means that minor variations in absorption rate do not clinically impact seizure control 3, 2
Important Caveats
While mixing with pudding is safe and effective, do not store pre-mixed preparations for later use, as stability data are lacking 1
Ensure the patient consumes the entire pudding mixture to receive the full prescribed dose 1
This approach is supported for both maintenance dosing and loading doses, though the evidence specifically evaluated crushed tablets rather than liquid formulation—the liquid form should theoretically mix even more readily 1, 4