Generic Keppra (levetiracetam): Cost, coverage, and side effects

In this article:

• Is there a generic for Keppra?
• What are the differences between brand name and generic Keppra?
• How much is generic Keppra?
• Is Keppra covered by insurance?
• Generic alternatives to Keppra

In this article

• Is there a generic for Keppra?
• What are the differences between brand name and generic Keppra?
• How much is generic Keppra?
• Is Keppra covered by insurance?
• Generic alternatives to Keppra

Keppra (Keppra XR, Elepsia XR) is an antiepileptic or anticonvulsant prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat seizures (epilepsy) in adults and children. It may be prescribed by itself or together with other medications to control seizures.

Is there a generic for Keppra?

The generic for Keppra is levetiracetam (levetiracetam ER). The prescription medicine was approved by the FDA in 1999.

What are the differences between brand name and generic Keppra?

Keppra and levetiracetam are almost identical medications. “Fundamentally, there is no difference between brand and generic medications,” says Erika Gray, Pharm.D., founder and Chief Medical Officer of Toolbox Genomics and clinical pharmacist at Zuckerberg San Francisco General Hospital and Trauma Center in San Francisco, California. “In this case, levetiracetam/Keppra has the exact same active ingredient. In fact, in order for a medication to be accepted as a generic, the company has to prove its medication is bioequivalent to the brand medication.”

Form

Keppra and its generic version are available in several forms, including oral tablets (immediate-release), extended-release (XR) oral tablets, oral solution (liquid), and intravenous (IV) injection.

Keppra and levetiracetam pills are oblong tablets in various colors. They can vary in terms of their inactive ingredients and manufacturer. 

Dosage

While dosing will vary depending on a person’s needs, Keppra and its generic version have the exact same dosage forms. 

Here’s a look at the dosages based on form:

• Tablets: 250 mg, 500 mg, 750 mg, and 1,000 mg
• Extended-release: 500 mg, 750 mg, 1,000 mg, and 1,500 mg
• Immediate-release tablets: 250 mg, 500 mg, 750 mg, and 1,000 mg
• Tablets for suspension: 250 mg, 500 mg, 750 mg, and 1,000 mg
• Oral solution (liquid): 100 mg/mL
• Injection (IV): 100 mg/mL

Dosage may be further adjusted for children under 12 years of age based on their body weight.

Inactive ingredients

“The place where Keppra and levetiracetam could differ is what type of inactive ingredients were used,” Dr. Gray says. “Occasionally, I have had patients who have had sensitivities to the excipients or dyes.”

Talk to your healthcare provider about any allergic reactions you’ve had to medications. And avoid taking medications with active or inactive ingredients that may be the source of the allergy or adverse effect.

Below is a general overview of Keppra’s uses, dosage, side effects, and other relevant information. 

How much is generic Keppra?

Another significant difference between Keppra and its generic counterpart is pricing. Here’s a breakdown of the price differences:

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Is Keppra covered by insurance?

Brand-name Keppra is usually not covered by health insurance plans. “Insurance companies typically cover levetiracetam, and they will be reluctant to cover Keppra unless there is a very specific documented reason that the patient cannot tolerate levetiracetam,” Dr. Gray says. But even with insurance coverage, your out-of-pocket costs may vary depending on copays, coinsurance, deductibles, or coverage gaps.

You can check out your plan’s formulary (a list of covered drugs) or call them directly to see which specific drugs are covered.

Generic alternatives to Keppra

If Keppra or its generic version is not safe for you to take due to certain inactive ingredients or other medical concerns, you and your healthcare provider can explore other generic anti-seizure drugs.

These include:

• Topiramate (Topamax)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin, Gralise)
• Divalproex sodium (Depakote)
• Phenytoin (Dilantin)
• Carbamazepine (Tegretol)

While Keppra is only FDA-approved to treat generalized tonic-clonic, myoclonic seizures, idiopathic generalized epilepsy, and juvenile myoclonic epilepsy, some healthcare providers may prescribe it off-label to manage other seizure disorders like static epilepticus and seizure prophylaxis. One study review also found that the anticonvulsant drug may reduce the frequency and intensity of headaches for people with migraines. 

Although generic Keppra is the go-to for many healthcare providers and insurance plans, there are a few instances where the brand-name may be the better option for patients. “A healthcare provider might recommend brand-name Keppra over generic levetiracetam if the patient loses seizure control after switching or if a patient reacts poorly to generic fillers,” says James Lyons, MD, a hospitalist, family medicine and emergency room physician, and medical consultant at Synergy Houses in West Chester, Pennsylvania. 

He adds that if a person receives a prescription for Keppra but prefers the generic version for reasons such as cost or allergic reactions to the inactive ingredients, a pharmacist may be able to make the switch—depending on local pharmacy and insurance rules. “If a doctor writes a prescription for Keppra, the pharmacist can usually dispense the generic levetiracetam instead,” he explains. “However, if the prescriber specifically writes ‘DAW’ (dispense as written) or checks the ‘no substitution box’ on the prescription, then the pharmacist must provide the brand Keppra.”

According to the prescribing information for Keppra, if you don’t keep up with daily doses or experience a shortage of the drug, you could experience serious withdrawal symptoms. 

“In rare cases, suddenly stopping levetiracetam could trigger status epilepticus (a prolonged seizure that’s a medical emergency),” Dr. Lyons says. “Doctors usually recommend tapering off under supervision rather than stopping suddenly.”

If you experience any severe withdrawal symptoms or serious side effects, please seek immediate medical attention by dialing 911 or visiting the nearest emergency room.

It’s important to note that Keppra withdrawal symptoms aren’t common—especially if you’re taking a lower dose. 

If there’s a shortage of Keppra, Dr. Gray recommends coordinating care with your healthcare provider. “I would suggest patients work with their provider to transition over to another medication and stabilize themselves on the new medication before levetiracetam supplies are significantly affected,” she says.