Levetiracetam(Keppra)
Anticonvulsant (treats TD by binding to synaptic vesicle protein 2A, also procognitive nootrophic effects)
- Mania3
- Tardive dyskinesia2
- SE-tremor
Features
Dosing
XR 500mg 1 qhs x7days, 2 qhs x7days then 3 qhs. Target 1000-3000, however 250 mg may work. XR form is better tolerated and $5/mth at costplusdrugs.com (otherwise may need to dose BID).
Management
Well tolerated overall, may improve cognition. Augmented mood stabilizers in 3 RCTs of mania.
TOLERABILITY: sedation, dizziness, dyscoordination. Weight neutral.
RISKS: Rare allergic rash (similar to lamotrigine, Stevens Johnson Syndrome). Rarely can cause irritability or other psychiatric side effects.
EMR Text
Mania
Levetiracetam use based on multiple controlled trials in bipolar mania (Mirzazadeh H et al, J Affect Disord. 2025;387:119526).
Levetiracetam’s side effects, including rare allergic rash, reviewed with patient.
Tardive Dyskinesia
Levetiracetam use based on controlled trials in dyskinesias, including tardive dyskinesia (Woods SW et al, J Clin Psychiatry. 2008;69(4):546-554).
Levetiracetam’s side effects, including rare allergic rash, reviewed with patient.