Levetiracetam, commonly known by its brand name Keppra, is an antiepileptic drug (AED) often used to treat seizures. While generally considered weight-neutral, meaning it's not usually associated with significant weight gain or loss, individual experiences can vary. This article explores the relationship between levetiracetam and weight changes, examining potential causes, research findings, and management strategies.
Understanding Levetiracetam
Levetiracetam is prescribed as an adjunctive therapy, meaning it's used alongside other medications, to manage various types of seizures, including:
- Focal aware onset seizures (simple partial seizures)
- Focal impaired awareness seizures (complex partial seizures)
- Myoclonic seizures associated with juvenile myoclonic epilepsy
- Secondarily generalized seizures (bilateral tonic-clonic seizures)
- Temporal lobe epilepsy
- Primary generalized tonic-clonic seizures
- Idiopathic generalized epilepsy
It is available in multiple forms, including tablets, oral solutions, liquid injections, and extended-release formulations, with twice-daily oral administration being the most common.
The exact mechanism by which levetiracetam reduces seizures isn't fully understood. It's believed to modulate the release of neurotransmitters, the brain's chemical messengers, differing from many anti-seizure medications that primarily work by slowing down electrical signals.
Common Side Effects of Levetiracetam
While weight change isn't a common side effect, levetiracetam can cause other adverse effects. The most frequently reported side effects include:
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- Dizziness
- Drowsiness
- Fatigue
- Headache
- Irritability
- Itchy or sore throat
- Nausea or vomiting
- Stuffy nose
More serious, though less common, side effects may include:
- Allergic reaction (anaphylaxis or angioedema)
- Anger
- Depression
- Mood and behavior changes
- Problems with coordination
- Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis)
- Suicidal thoughts or behavior
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Levetiracetam's Impact on Weight: A Closer Look
Although levetiracetam is generally considered weight-neutral, some individuals may experience weight changes, either weight loss or weight gain, while taking it.
Research Findings
A study published in Epilepsy Research compared levetiracetam to a placebo in nearly 1,000 participants with epilepsy. The findings indicated that a small percentage of those taking levetiracetam experienced weight changes, but the difference wasn't significant compared to the placebo group, supporting the notion that levetiracetam is weight-neutral.
Levetiracetam and Weight Loss
Weight loss is not a commonly reported side effect of levetiracetam. However, a small study focusing on 19 individuals suggested a possible link between levetiracetam and weight loss. The study author referenced previous research indicating weight loss in older adults with anxiety who were taking levetiracetam.
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The reasons behind levetiracetam-related weight loss remain unclear, but researchers hypothesize that it may involve the body's mechanisms regulating hunger and fullness signals. Some researchers suggest women might be more susceptible to this side effect, but further research is needed to confirm this and identify other potential risk factors.
Other side effects of levetiracetam, such as nausea, vomiting, or depression, may also contribute to weight loss.
Levetiracetam and Weight Gain
While weight loss is more commonly associated with levetiracetam than weight gain, some individuals do report gaining weight. In one small study, a few participants gained a modest amount of weight after starting levetiracetam.
Mood changes or depression, which can occur as side effects of levetiracetam, may lead to increased food cravings and subsequent weight gain.
Epilepsy, Lifestyle, and Weight Changes
It's important to consider that weight changes in people with epilepsy may not always be directly caused by levetiracetam or other anti-epileptic drugs.
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The Role of Lifestyle Factors
Lifestyle factors, particularly physical activity levels, can significantly impact weight. Studies suggest that individuals with epilepsy tend to be less physically active than the general population, potentially contributing to weight gain. Even though most epilepsy syndromes don’t directly cause weight gain, obesity is a common condition in people with epilepsy, according to a 2013 study in the journal Epilepsy & Behavior.
Other Anti-Epileptic Drugs
Weight changes in individuals with epilepsy may also be related to other anti-epileptic drugs they are taking. Some AEDs are more strongly associated with weight gain, including:
- Carbamazepine (Tegretol)
- Divalproex sodium (Depakote)
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)
- Vigabatrin (Sabril)
Conversely, some AEDs are associated with weight loss:
- Felbamate (Felbatol)
- Topiramate (Topamax)
- Zonisamide (Zonegran)
Managing Weight Changes While Taking Levetiracetam
If you experience significant weight gain or loss while taking levetiracetam, it's important to consult your doctor. They can help determine the cause of the weight change and recommend appropriate management strategies.
Medical Evaluation and Monitoring
Your doctor may recommend regular weight monitoring to track any changes. Never discontinue levetiracetam or any other medication without consulting your doctor, as this can have serious consequences.
Adjustments to Medication
Your doctor can assess the risks and benefits of adjusting your AED regimen. This may involve:
- Lowering the levetiracetam dose
- Switching to a different anti-epileptic drug
- Addressing other side effects that may be contributing to weight changes
Dietary Guidance
A doctor or registered dietitian can provide personalized dietary advice to help manage weight changes. This may include recommendations on what to eat and what to avoid while taking levetiracetam.
Physical Activity
Regular physical activity is crucial for maintaining a healthy weight. Discuss with your doctor the safest and most appropriate types of exercise for you, considering your epilepsy and overall health.
Additional Considerations
- Regular Medical Check-ups: Regular visits to the doctor are essential, especially during the first few months of levetiracetam treatment, to monitor its effectiveness and detect any unwanted effects through blood tests.
- Pregnancy: If you become pregnant while taking levetiracetam, inform your doctor immediately. They may want you to join a pregnancy registry for patients taking seizure medication.
- Mood and Behavior Changes: Levetiracetam can cause mood or behavior changes, coordination problems, or unusual fatigue. Report any feelings of depression, anxiety, anger, restlessness, or thoughts of self-harm to your doctor immediately.
- Dizziness and Drowsiness: Be aware that levetiracetam may cause dizziness, drowsiness, or decreased alertness. Avoid driving or operating heavy machinery until you know how the medication affects you.
- Allergic Reactions: Levetiracetam can cause serious allergic reactions, including anaphylaxis or angioedema. Seek immediate medical attention if you experience rash, itching, swelling, trouble breathing, or swallowing.
- Serious Skin Reactions: Serious skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis can occur. Contact your doctor immediately if you experience blistering, peeling, or loosening of the skin, chills, cough, or other related symptoms.
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Report any symptoms such as black, tarry stools, chest pain, chills, cough, fever, painful urination, sore throat, swollen glands, unusual bleeding or bruising, or unusual tiredness, as these may indicate DRESS.
- Withdrawal: Do not stop taking levetiracetam without consulting your doctor, as sudden discontinuation can lead to more frequent seizures.
- Surgical Procedures: Inform any doctor or dentist treating you that you are taking levetiracetam.
- Medical Tests: Be aware that levetiracetam may affect the results of certain medical tests.
- Behavioral Symptoms: Non-psychotic behavioral symptoms, such as aggression, agitation, anger, anxiety, and depression, have been reported in both adult and pediatric patients.
- Blood Cell Count: Levetiracetam may lower the number of certain blood cells, increasing the risk of bleeding or infection.
- Blood Pressure: In some clinical trials, elevated diastolic blood pressure has been observed.