Levetiracetam

What is levetiracetam?

Levetiracetam (brand names: Keppra®, Elepsia®, Spritam®) is an anticonvulsant used to treat seizures and epilepsy. In dogs, it is typically used in combination with other anticonvulsants, while in cats, it is used alone or in combination.

Its use in cats, dogs, and horses to treat seizures and epilepsy is off label (extra label). Many drugs are commonly prescribed for off-label use in veterinary medicine. 

“Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How is levetiracetam given?

• Levetiracetam is given by mouth in the form of a tablet, extended-release tablet, liquid oral solution, or an injection typically given in the clinic.
• Measure liquid forms carefully.
• Do not crush extended-release tablets, and don’t allow your pet to chew the tablets. Doing so can break the drug structure that allows it to release slowly.
• Levetiracetam may be given with or without food; however, if your pet vomits after dosing on an empty stomach, give future doses with food.
• Do not stop this medication abruptly, to avoid withdrawal seizures.

Some compounded products marketed as extended release may be able to be split or crushed. However, always consult with your veterinarian prior to splitting.

This medication should take effect within 1 to 2 hours; however, effects may not be noted outwardly, so laboratory tests may be needed to evaluate this medication’s effectiveness.

What if I miss giving my pet the medication?

If you miss a dose, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects?

Levetiracetam may cause the following side effects in dogs:

• Sleepiness
• Incoordination

Levetiracetam may cause the following side effects in cats:

• Decreased appetite,
• Incoordination,
• Drooling,
• Sleepiness

Serious adverse reactions may occur. If any of the following signs develop, stop giving levetiracetam and contact your veterinarian immediately:

• Persistent vomiting
• Sudden changes in behavior

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

DO NOT USE levetiracetam in:

• Pets that are allergic to it

USE WITH CAUTION in:

• Pets with kidney disease
• Pets that are pregnant or nursing

Do not stop this medication abruptly, to avoid withdrawal seizures.

Are there any drug interactions I should be aware of?

Several medications should be used with caution when given with levetiracetam, including:

• Central nervous system (CNS) depressants
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phenobarbital

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Monitor and document your pet’s seizure activity at home.
• Monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.
• Your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects.
• Your veterinarian may monitor therapeutic blood levels.
• Routine general bloodwork may be checked regularly (every 6–12 months).

How do I store levetiracetam?

• Store the tablets and liquid oral solution at room temperature, around 77°F (25°C); excursions permitted between 59°F and 86°F (15°C and 30°C).
• Keep the container out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.