India · Focal Seizures · Juvenile Myoclonic Epilepsy · Generalised Tonic-Clonic · IV Loading · Paediatric · Levipil · Levroxa · Leviria · Keppra
eGFR >80: Standard 500–1500 mg BD
eGFR 50–80: 500–1000 mg BD
eGFR 30–50: 250–750 mg BD
eGFR <30: 250–500 mg BD
Dialysis: 500–1000 mg after dialysis (supplemental dose)
| Patient | Starting dose | Titration | Target maintenance | Maximum |
|---|---|---|---|---|
| Adult (≥16yr) | 500 mg BD | +500 mg BD every 2–4 weeks | 1000–1500 mg BD | 1500 mg BD (3g/day) |
| Child 4–16yr | 10 mg/kg BD | +10 mg/kg BD every 2 weeks | 20–30 mg/kg BD | 30 mg/kg BD (60 mg/kg/day) |
| Infant 6m–4yr | 10 mg/kg BD | +10 mg/kg BD every 2 weeks | 25 mg/kg BD | 30 mg/kg BD |
| IV (all ages) | Same as oral equivalent | Infuse over 15 minutes | Same as oral | 1500 mg BD IV |
| Status epilepticus | 30–60 mg/kg IV (max 4500 mg) | Single loading dose over 15 min | Followed by oral/IV maintenance | 4500 mg single load |
Levetiracetam (Levipil, Levroxa, Keppra) has rapidly become one of the most widely used antiepileptic drugs in India due to its favourable pharmacokinetic profile: no significant drug-drug interactions (it does not induce or inhibit hepatic cytochrome P450 enzymes), no routine therapeutic drug monitoring required, broad spectrum of seizure control, and the availability of an IV formulation that is bioequivalent to oral — allowing seamless transitions between routes. It is licensed for focal seizures (with or without secondary generalisation), juvenile myoclonic epilepsy, and primary generalised tonic-clonic seizures, as monotherapy or adjunct therapy in adults and as adjunct therapy in children from 6 months of age.
Unlike older antiepileptics (phenytoin, carbamazepine, phenobarbitone), levetiracetam does not induce hepatic enzymes. This means it does not reduce the efficacy of oral contraceptives (critical for women of reproductive age), does not alter the levels of other co-prescribed medications (anticoagulants, immunosuppressants, antiretrovirals), and does not complicate polypharmacy in elderly patients. This makes it particularly valuable in India where polypharmacy is common and contraceptive failure from enzyme-inducing AEDs is a significant clinical and social problem.
Levetiracetam's most clinically significant adverse effect is neuropsychiatric — irritability, agitation, aggression, depression, and rarely psychosis — occurring in approximately 10–15% of patients. These effects can appear at any dose and may be more common in patients with pre-existing psychiatric conditions. Patients and families must be explicitly counselled before starting: if mood changes, unusual irritability, or behavioural changes develop, report to the prescribing physician immediately. Dose reduction usually resolves neuropsychiatric effects; if severe, switching to an alternative AED may be necessary. This side effect is frequently underreported by patients and under-attributed to the drug in Indian clinical practice.
Levetiracetam is 66% renally excreted unchanged. In CKD, drug accumulation causes increased sedation and an amplified risk of neuropsychiatric adverse effects. Dose reduction is mandatory in all patients with eGFR below 80 mL/min. This is particularly relevant in elderly Indian patients with epilepsy, many of whom have unrecognised CKD. Check eGFR before starting and annually during treatment.