First-lineKeppra
Levetiracetam
SV2A synaptic vesicle modulator antiepileptic
Alternative first-line AED in pregnancy — clean interaction profile.
OralIV
First-line for
- Focal/generalised epilepsy in pregnancy
- Status epilepticus (second-line)
Mechanism
Binds SV2A on presynaptic vesicles → modulates neurotransmitter release across excitatory synapses.
"Keppra = kind pregnancy, kind interactions"
- Renal clearance rises ~60% in pregnancy — expect dose ↑
- Watch behavioural side effects (Keppra rage)
- IV = PO 1:1
Dosing
- Start
- 250–500 mg BD; titrate to 1000–3000 mg/day
- Pregnancy
- Check levels each trimester; may need 25–50% dose ↑
- Status epilepticus
- 60 mg/kg IV over 10 min (max 4.5 g)
Contraindications
- CautionSevere renal impairment — dose reduce
Side effects
- Behavioural (irritability, depression, 'Keppra rage')
- Somnolence, fatigue
- Headache
- Rare pancytopenia
Fetal & maternal notes
- • MCM rate ~2.4% (Encomora 2018) — comparable to background
- • Preferred for women considering pregnancy alongside lamotrigine
Key interactions
No CYP interactions
OKSafe with COC, warfarin, DOACs
Clinical pearls
- 💡 Excellent choice for polypharmacy patients
- 💡 IV/PO switch 1:1 makes labour management easy
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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