Levetiracetam dosage, forms, and strengths

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician
Updated Feb 11, 2025  •  Published Feb 11, 2025
Datos Verificados
In this article:

Key takeaways

  • Levetiracetam treats seizure disorders.

  • Medication is taken orally daily.

  • Take doses at the same time every day.

  • Take doses without regard to food.

Levetiracetam is a generic prescription anticonvulsant used alone or along with other drugs for certain types of seizures. The drug helps prevent seizures by slowing down nerve activity. Doses are taken orally every day—twice daily for immediate-release formulations, and once daily for the extended-release version. If a patient cannot swallow pills, an oral disintegrating tablet is available, or a healthcare professional can administer the medication via intravenous injections.

Levetiracetam forms and strengths

Levetiracetam comes in several dosage forms as well as several brand names, including Keppra, Roweepra, Elepsia XR, and Spritam:

  • Tablets: 250 mg, 500 mg, 750 mg, 1,000 mg

  • Disintegrating oral tablets: 250 mg, 500 mg, 750 mg, 1000 mg

  • Extended-release tablets: 500 mg, 750 mg, 1,000 mg, 1,500 mg

  • Tablets for suspension: 250 mg, 500 mg, 750 mg, 1,000 mg

  • Oral solution (liquid): 100 mg/mL

  • Injection: 100 mg/mL

Levetiracetam dosage for adults

Levetiracetam is FDA approved for the adjunctive therapy of myoclonic seizures, partial seizures, and tonic-clonic seizures. Healthcare professionals may also use it off-label to treat prolonged seizures (status epilepticus) or to prevent seizures after a traumatic brain injury or subarachnoid bleed in the brain.

Levetiracetam is safe to take. The only contraindication is a history of an allergic or drug reaction to levetiracetam. 

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Levetiracetam dosage chart
Indication Starting dosage Standard dosage Maximum dosage
Partial onset seizures 500 mg levetiracetam IR taken twice daily OR 1,000 mg levetiracetam ER taken once daily 1,500 mg levetiracetam IR taken twice daily  OR 3,000 mg levetiracetam ER taken once daily 3,000 mg daily
Juvenile myoclonic seizures 500 mg levetiracetam IR taken twice daily 1,500 mg levetiracetam IR taken twice daily 3,000 mg daily
Tonic-clonic seizures 500 mg levetiracetam IR taken twice daily 1,500 mg levetiracetam IR taken twice daily 3,000 mg daily

Levetiracetam dosage for seizures

Levetiracetam is an anti-seizure drug. As maintenance therapy, it helps reduce the frequency and severity of seizures. Doctors prescribe levetiracetam alone as monotherapy, but seizures are often difficult to stop completely, and polytherapy (taking more than one antiseizure medication) is often needed. 

Levetiracetam treats only some types of seizure disorders in adult patients: partial onset seizures, juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures.

People usually take immediate-release levetiracetam twice daily, but patients with partial seizures can be prescribed extended-release tablets, which require only one dose daily. People who can’t swallow a tablet can opt for liquid or oral-disintegrating versions. If a person can’t take medication orally, doctors will use intravenous injections. 

Doses start low at 1,000 mg daily (two 500 mg tablets twice daily). Doses increase by 1,000 increments every two weeks to reach the target dose of 3,000 mg per day (1,500 mg twice daily). 

  • Standard adult dosage for seizure disorders: 3,000 mg daily 

  • Maximum adult dosage for seizure disorders: 3,000 mg daily 

Levetiracetam dosage for children

The FDA approved levetiracetam for use in pediatric patients, but the age range depends on the type of seizure disorder being treated:

  • Partial seizures: levetiracetam can be used in children as young as 1 month old—dosages are based on weight for children younger than 4 years of age 

  • Juvenile myoclonic seizures: levetiracetam is only approved in children 12 years of age and older

  • Tonic-clonic seizures: levetiracetam treats children 6 years of age and older

Extended-release levetiracetam is only approved to treat partial seizures in adults and children as young as 12. Dosages are the same for adults and children.

There is no children’s formulation of levetiracetam, but doctors will prescribe levetiracetam oral solution for children 4 years of age or younger or children who weigh less than 20 kg (44 lbs.). They can also use intravenous injections. Unlike the use of tablets, oral solution or injection doses will be based on the child’s exact body weight.

  • Standard levetiracetam dosage for children 1–6 months of age: 7–21 mg/kg levetiracetam oral solution taken twice daily

  • Standard levetiracetam dosage for children 6 months to 4 years of age: 10–25 mg/kg levetiracetam oral solution or injection administered twice daily

  • Standard levetiracetam dosage for children 4–16 years of age and weighing 20–40 kg: 10–30 mg/kg levetiracetam oral solution or injection or 250–750 mg immediate-release tablets administered twice daily

  • Standard levetiracetam dosage for children 4–16 years of age and weighing 40 kg or more: 10–30 mg/kg levetiracetam oral solution or 250–750 mg immediate-release tablets taken twice daily

  • Standard extended-release levetiracetam dosage for children 12 years of age and older and weighing 50 kg or more: 250–750 mg extended-release tablets taken once daily

Levetiracetam dosage by age and weight

Age Weight Recommended dosage (liquid) Recommended dosage (tablets)
1–6 months 7–21 mg/kg taken twice daily
6 months–4 years 10–25 mg/kg taken twice daily
4–16 years 20–40 kg 10–30 mg/kg taken twice daily 250–750 mg IR tablets taken twice daily
≥40 kg 500–1,500 mg IR tablets taken twice daily
≥12 years of age  ≥50 kg 1,000–3,000 mg extended-release tablets taken once daily

Levetiracetam dosage restrictions

Levetiracetam dosages require no modifications for people with liver disease (hepatic impairment). However, doses must be individualized for people with kidney disease as follows:

  • Patients with renal impairment (kidney disease): 

    • Mild renal impairment (creatinine clearance 50–80 mL/min): 500 to 1,000 mg taken twice daily

    • Moderate renal impairment (creatinine clearance 30–50 mL/min): 250 to 750 mg taken twice daily

    • Severe renal impairment (<30 mL/min): 250 to 500 mg taken twice daily

    • End-stage renal disease and dialysis: 500 to 1,000 mg taken once daily

Levetiracetam dosage for pets

Veterinarians use levetiracetam for seizure disorders in dogs and cats. It’s not their first choice, but they will use it for refractory epilepsy not controlled by other drugs. 

Veterinarians consider levetiracetam a safe drug. The most common side effects in dogs are vomiting and salivation. 

The standard levetiracetam dosage in dogs and cats is 20 mg per kilogram of body weight given every eight hours. 

How to take levetiracetam

Levetiracetam comes in a variety of dosage formats, including extended-release formulations. Check the Medication Guide from the pharmacist before you start taking doses to make sure you are taking the medicine correctly. Here are a few guidelines:

  • Follow all the prescriber’s instructions.

  • Do not change the dose or take doses more frequently than prescribed. 

  • Please read the Drug Information sheet and the Medication Guide from the pharmacist that comes with this medicine. 

  • Take doses at the same time each day.

  • Take doses with or without food.

  • Do not stop taking levetiracetam without consulting with the prescriber.

  • Levetiracetam immediate-release tablets

    • Take doses twice daily unless instructed otherwise.

    • Swallow the tablet whole. Do not crush, break, or chew it.

    • Store the tablets at room temperature. Protect from heat and light.

  • Extended-release levetiracetam tablets

    • Take doses once per day unless instructed otherwise.

    • Swallow the tablet whole. Do not crush, break, or chew it.

    • Store the tablets at room temperature. Protect from heat and light.

  • High-dose extended-release levetiracetam tablets (Elepsia XR)

    • Take doses once daily unless instructed otherwise.

    • Swallow the tablet whole. Do not crush, break, divide, or chew it.

    • Each tablet has a blue layer and a white layer. If either the blue or white layer is missing, do not take the tablet. 

    • Some inert parts of the tablet may be visible in stools. This is normal.

    • Store the tablets at room temperature protected from light.

  • Tablets for suspension (Spritam)

    • Take Spritam tablets two times daily unless instructed otherwise.

    • Tablets can be dissolved in the mouth or in a small amount of liquid.

    • Dry your hands before removing a Spritam tablet from the blister pack.

    • Peel back the foil.

    • Empty the tablet from the blister pack into a dry hand. Do not push the tablet through the foil.

    • Place the tablet on your tongue.

    • Take a sip of liquid.

    • Allow the tablet to fully dissolve in the liquid. This usually takes about 11 seconds but could take as long as 27 seconds.

    • When the tablet has fully dissolved, swallow the solution.

    • The tablet can also be placed in one tablespoon of liquid and dissolved by swirling the liquid. Swallow the suspension immediately. If any medicine is left over, add a bit more liquid and drink it.

    • Store Spritam tablets in their blister pack at room temperature.

  • Levetiracetam oral solution

    • Take doses twice daily unless instructed otherwise.

    • Ask the pharmacist for a calibrated oral syringe, dropper, or medicine cup to measure doses. Do not use kitchen measuring devices or tableware.

    • Store levetiracetam oral solution at room temperature, away from heat and light.

Levetiracetam dosage FAQs

Levetiracetam vs. levetiracetam XR/ER: What’s the difference in doses? 

The two formulations have the same daily dose of levetiracetam, though extended-release levetiracetam is taken only once daily. 

What happens if I miss a dose of levetiracetam?

Take a missed dose as soon as you remember it. If it’s almost time for the next dose, skip the missed dose and take the next dose as scheduled. Do not double up doses to compensate for a missed dose.

How do I stop taking levetiracetam?

Do not stop taking levetiracetam without first making a plan with your healthcare provider. Sudden discontinuation of levetiracetam could cause frequent and potentially severe seizures. The doctor may need to taper the dose gradually to prevent seizures.

What is the maximum dosage for levetiracetam?

The maximum dosage of levetiracetam is 3,000 mg daily.

What happens when you mix levetiracetam and alcohol?

Doctors usually advise people with seizures to avoid alcohol. Drinking can trigger seizures, and seizure medications like levetiracetam can lower the body’s tolerance for alcohol. Combining alcohol with levetiracetam will also worsen side effects like extreme drowsiness, poor coordination, and dizziness. Consider also that most patients will also be taking other sedating anticonvulsants like phenobarbital, diazepam, or lorazepam, so all these sedative drug interactions could add up to significant impairment when alcohol is added to the mix.

Is it safe to take levetiracetam during pregnancy?

Healthcare providers aren’t sure if levetiracetam is safe for an unborn baby, but it is associated with birth defects in animals. Pregnant women are encouraged to register with the North American Antiepileptic Drug (NAAED) pregnancy registry when taking levetiracetam. 

One major concern is that levetiracetam’s pharmacokinetics change in the later stages of pregnancy. For reasons not understood, pregnant women eliminate the drug more quickly, so the drug may be less effective at preventing seizures. Clinicians are cautioned to regularly monitor pregnant women to make sure the drug is working.

Is it safe to take levetiracetam while breastfeeding?

Levetiracetam is present in breast milk and detectable at low levels in a nursing infant. However, sometimes levetiracetam levels could be high in some women’s breast milk and make the baby sleepy. Women can take the drug while breastfeeding but should monitor the baby for unusual drowsiness. Immediately report any problems to the prescriber. 

What are the side effects of levetiracetam?

In clinical trials, the most common side effects of levetiracetam were drowsiness, weakness, dizziness, infection, and aggression. Serious adverse effects include suicidal thoughts, abnormal behaviors, hallucinations, high blood pressure, kidney problems, liver problems, and severe allergic or drug reactions such as angioedema, anaphylaxis, and skin reactions.

Sources

Medically reviewed by Leslie Greenberg, MD
Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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