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One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.

We here at Crazy Meds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage1. More and more doctors are agreeing with us2. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.

1.  Keppra-XR’s (levetiracetam)’s dosage and doses

Per the PI sheet it’s two 500mg tablets (or whatever your dosage is) of Keppra XR once a day.
For the immediate-release version it’s one 500mg tablet twice a day.

We’re good with that, unless you’re experiencing psychiatric effects, especially irritability and rage. In which case we recommend taking Keppra XR twice a day and immediate-release Keppra three times a day. You can split the immediate-release tablets, and they don’t even make Keppra XR in the 1000mg size.
If they start you on 500mg of Keppra XR, which is perfectly sane, you’re screwed when it comes to taking it twice a day, as that is currently the smallest size now available.

2.  Best way to take / special instructions for taking Keppra-XR (levetiracetam)

If you are taking Keppra XR only once a day, you’ll probably want to try taking it at night to begin with, as it’s far more likely to make you sleepy than to keep you awake.

Taking Keppra with food will delay Keppra’s peak availability by an average of an hour and a half, and can sometimes cut down on how much Keppra you absorb by up to 20%. What does that mean as far as taking it is concerned? You’ll be better off taking Keppra on an empty stomach, but it won’t be that big of a deal if you need to take it with food in the very unlikely chance it gives you tummy troubles.

3.  Keppra-XR’s (levetiracetam)’s titration (dosage increase)

According to UCB you can start Keppra XR at 1000mg once a day and that’s it, sort of like Invega. They said the same thing about the immediate-release version as well, although with two 500mg doses. Although 500mg is the low-end of the therapeutic range. If you haven’t achieved symptom control, or you lose symptom control, your doctor may increase your dosage by 1000mg a day (taken once a day for KeppraXR and two 500mg dose for immediate-release Keppra) each week until you hit the maximum recommended dosage of 3000mg a day.
One moderately-sized double-blind study even concludes you can start at 2000–4000mg a day if required. Even Dr. Faught in the edition of PeerView in Review on traditional and new antiepileptic drugs thinks thinks that Keppra can be titrated as stated, unlike any of the others (including Ortho-McNeil’s Topamax, the sponsor of the program). Guess what? I disagree.
There is a REASON they make 250mg tablets, and there is a REASON they are so easy to cut in half! I don’t think most people need to start quite that low, but 500mg, taken as 250 twice a day, is reasonable to start if you’re not completely flipping out. That’s where the off-label bipolar studies show them starting, by the way. Then a 250mg step-up weekly, 125mg if it hits really hard. Not every 5 days, A WEEK. SEVEN DAYS. Those extra 2 days can make a big difference in getting used to a med. If less than traditional doses work for someone, then fine and wonderful. I am a big believer in the correct dose isn’t necessarily what the PI sheet says, it is the one that works.

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare.

4.  How to stop taking Keppra-XR (levetiracetam)

Slowly, unless being on Keppra is sucking serious ass. And this is why I don’t like starting a med at a therapeutic dose. OK. End soapbox. Generally, the way you went up—was it in 250mg increments, 500mg increments? Please say it wasn’t in 1000mg increments. How you went up on Keppra is how you should go down from Keppra —500 to 250 every 5 to 7 days.

5.  Discontinuation symptoms

Pretty much the same as all AEDs: headaches, spaciness, return of symptoms (i.e. seizures).

6.  Notes, tips, helpful hints, etc. for discontinuing Keppra-XR (levetiracetam)

‹ How Long & How Likely To Work, Comparisons with Other Meds | Keppra-XR Index | Pros & Cons, Interesting Stuff Your Doctor Didn’t Tell You ›
Crazy Meds Comprehensive Keppra-XR pages

Bibliography

1 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

2 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy*, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

*Link to Topiramate in the treatment of partial and generalized epilepsy Scroll down to the section “Practical use of topiramate”


Date created Tuesday, 04 October 2011 at 11:12:28 Page Creator: Last edited by:

Crazy Meds’ Suggestions on How Much to Take, How to Increase the Dosage, and How to Stop Taking Keppra-XR is copyright 2011


Page design and explanatory material copyright © 2004 - 2012 Jerod Poore. All rights reserved.

Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you.
The information on Crazy Meds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
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Crazy Meds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Firefox or Safari, which is what a plurality of visitors use. And I’m running Windows XP3. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazy Meds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazy Meds is not responsible for whatever weird shit your browser does or does not do when you read this site2.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]


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