question-icon

I take levetiracetam er 500 mg/3 per day. I took

default
Posted on Sat, 16 Mar 2019
Question: I take levetiracetam er 500 mg/3 per day. I took the three and an hour later accidentally took 3 more. Should I be concerned?
default
Follow up: Dr. Dariush Saghafi (0 minute later)
I take levetiracetam er 500 mg/3 per day. I took the three and an hour later accidentally took 3 more. Should I be concerned?
doctor
Answered by Dr. Dariush Saghafi (39 minutes later)
Brief Answer:
You may have a bit more fatigue or lightheadedness in the morning...BUT....

Detailed Answer:
Otherwise, young lady....you should be fine.

It is not unusual for us to some times give what are called LOADING DOSES of antiepileptic medications to patients who have never taken the drug before for the purpose of trying to blood levels up to snuff as quickly as possible. So in essence what you did accidentally was to take what we often times give patients who are just getting started on an antiepileptic drug.

The major side effects from any antiepileptic is going to be GI upset, FATIGUE, somnolence, IMBALANCE, and blunting of cognitive capacities. If you notice any of these things happening it is likely going to be the side effect of those extra tablets you took. However, it also would not XXXXXXX me if NOTHING HAPPENED of a significant nature because the normal recommended dose of levetiracetam can actually be round around 2000-3000 mg. daily. So again, you're within the norms of what the manufacturer and studies show as recommended.

I will mention that I do not know why you are being dosed 3x per day instead of the usual and commonly dosed regimen of TWICE DAILY. Using 500mg. 3x/day may not be as effective due to the way the drug is designed pharmaceutically compared with something like 750mg. TWICE a day (total daily is still 1500mg. but divided in 2 doses).

I would recommend that for the next 12-24 hrs. you exercise a bit of caution while walking, climbing or descending stairs, and I would not jump out of a chair or bed before sitting on the bed or the chair for a moment and then, slowly coming to a standing possession with slow walking to take place just to be sure that the extra doses of medication have not some how created a more complicated situation without you directly being aware UNTIl you've become engaged in an activity that typically would not show itself as abnormal unless you were suffering from dizziness, etc.

I do hope this information has given you some perspectives on this simple BUT COMPLEX topic of HEALTH ANXIETY....notice that I referred to this query in that light. In other words, there is no plausible evidence given what you've given us the initial symptoms that you suffer from either MS or ALS....Isn't that good news? Now, you can enjoy seeing how far below zero it gets up there in Maine compared to XXXXXXX where I'm at!
LOL!.

If your questions have been satisfactorily assessed and answered would you do me the favor of closing this QUERY? Also, if you could provide some positive feedback and a 5 star rating if you feel it is so deserving well, that would just put the chocolate chip on top of the mountain of Whipped Cream for me!

This query has required 15 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi (0 minute later)
Brief Answer:
You may have a bit more fatigue or lightheadedness in the morning...BUT....

Detailed Answer:
Otherwise, young lady....you should be fine.

It is not unusual for us to some times give what are called LOADING DOSES of antiepileptic medications to patients who have never taken the drug before for the purpose of trying to blood levels up to snuff as quickly as possible. So in essence what you did accidentally was to take what we often times give patients who are just getting started on an antiepileptic drug.

The major side effects from any antiepileptic is going to be GI upset, FATIGUE, somnolence, IMBALANCE, and blunting of cognitive capacities. If you notice any of these things happening it is likely going to be the side effect of those extra tablets you took. However, it also would not XXXXXXX me if NOTHING HAPPENED of a significant nature because the normal recommended dose of levetiracetam can actually be round around 2000-3000 mg. daily. So again, you're within the norms of what the manufacturer and studies show as recommended.

I will mention that I do not know why you are being dosed 3x per day instead of the usual and commonly dosed regimen of TWICE DAILY. Using 500mg. 3x/day may not be as effective due to the way the drug is designed pharmaceutically compared with something like 750mg. TWICE a day (total daily is still 1500mg. but divided in 2 doses).

I would recommend that for the next 12-24 hrs. you exercise a bit of caution while walking, climbing or descending stairs, and I would not jump out of a chair or bed before sitting on the bed or the chair for a moment and then, slowly coming to a standing possession with slow walking to take place just to be sure that the extra doses of medication have not some how created a more complicated situation without you directly being aware UNTIl you've become engaged in an activity that typically would not show itself as abnormal unless you were suffering from dizziness, etc.

I do hope this information has given you some perspectives on this simple BUT COMPLEX topic of HEALTH ANXIETY....notice that I referred to this query in that light. In other words, there is no plausible evidence given what you've given us the initial symptoms that you suffer from either MS or ALS....Isn't that good news? Now, you can enjoy seeing how far below zero it gets up there in Maine compared to XXXXXXX where I'm at!
LOL!.

If your questions have been satisfactorily assessed and answered would you do me the favor of closing this QUERY? Also, if you could provide some positive feedback and a 5 star rating if you feel it is so deserving well, that would just put the chocolate chip on top of the mountain of Whipped Cream for me!

This query has required 15 minutes to research, investigate, and prepare a response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Dariush Saghafi (5 minutes later)
I think you misunderstood the dosage: it is 3 pills once a day 500 mg each. So when my next dosage is scheduled for tomorrow night do I go ahead and take it?
default
Follow up: Dr. Dariush Saghafi (0 minute later)
I think you misunderstood the dosage: it is 3 pills once a day 500 mg each. So when my next dosage is scheduled for tomorrow night do I go ahead and take it?
doctor
Answered by Dr. Dariush Saghafi (9 hours later)
Brief Answer:
Thanks for the clarification on your dosing regimen.

Detailed Answer:
Ahhh....yes, you're correct....my bad. I thought it was 1 pill 3x/day. At any rate, the total daily dose still comes out to what I had thought....and the repetition of that dose 1 hr. later should not've caused a problem. The proof in that pudding is that at the time you were writing your 2nd response back....(17-18 hrs ago) you were not writing anything about adverse effects. I would've expected the negative things of having duplicated the dose to have shown themselves within several hrs. at most.

The fact that they didn't suggests to me that you're going to be OK.

As far as "skipping" a dose....that is really going to depend on what YOUR DOCTOR or NEUROLOGIST thinks about the situation. There are 2 ways to look at what happened. One would be to treat it AS IF you had been given a LOADING dose of the medication to start taking just to get your blood levels up to snuff a bit quicker. In that instance the patient would be expected to be taking their medications on a daily/nightly basis (however, prescribed) as ordered going forward, so missing the next night's dose would not be proper.

The 2nd way to look at it would be that since you doubled the dose so close together that your blood concentrations would go to a point whereby "skipping" a day might allow them to come back down to more "expected" levels for the dosing regimen you were given and so it would be OK to not take the dose the following day. The problem with that thought process is that blood concentrations are not known nor can they be accurately predicted by saying doubling the dose doubles the blood concentration so that skipping a day is going to correct that...it sounds logical to say that....but the way the body metabolizes medications is all be so predictable.

In my patients I much prefer they stick with the ordered schedule of daily/nightly dosings without missing and they simply fall into that habit, no mater whether they accidentally took an extra dose.

More of a concern to me in your case would be to understand how you could've made that error in the first place since the time between one dose and the duplicate was only 1 hr. Did you mix the pills up thinking they were some other medication? Or how did it actually happen. To me that's a more important detail to ferret out right now so that it doesn't happen again.

Skipping or not skipping the dose on your Keppra needs to be a decision that your doctor makes. I cannot speak for them. I would therefore, strongly recommend you place a call to their office and report the incident and find out how they wish you to proceed. I guarantee they will not be happy if I recommend something not in accordance with their thinking and that you decided to take my advice as opposed to calling them to get a clarification.

I will make one comment about the dosing of once daily of 1500mg. for whatever your condition may be....to let you know that the more commonly way to prescribe this medication is TWICE daily. So that if your doctor wanted you to take a total of 1500mg. in 1 day it would be more commonplace to order 750mg. twice daily. Again, the rationale for saying this is in the way the drug is manufactured, formulated, and eliminated from the body. If you only take the drug once daily then, what could happen is that you may get a large spike of medication in your bloodstream within an hr. or 2 but because of elimination kinetics...that drug may be virtually cleared in 20 hrs. at most...and certainly by 24 hrs. when your next dose is due...you'll have relatively low levels in the bloodstream....as opposed to taking the drug twice daily in which case there would be a smoother decline of the medication by metabolism and your body would not experience those giants peaks and valleys during which time things may react or cause problems due to a relative lack of drug that is supposed to be covering you....for seizures maybe, or whatever condition they're treating..

And so, I would ask the doctor about the dosing of the medication as once daily since that it a bit different from how it is generally given.

So Let's recap everything for clarity. Here are my 3 recommendations:

1. Report what happened to your doctor right now...call their office, they've got to have someone on call for the practice that can answer this question (either the doctor, an NP/PA, or another doctor covering).

2. Allow them to make the decision as to whether or not you should take the daily dosing on schedule despite the duplication of medication. (In my patients, if I were treating someone for seizure/epilepsy...I would most likely tell them to stay on schedule with their upcoming dose and not skip anything based on what happened).

3. Correct whatever happened that allowed you to duplicate that medication dose so close to when you took the first dose (alarm clock pill box, more clear labeling of medication bottles, etc).

If I've answered your questions satisfactorily would you be so kind as to CLOSE THE QUERY and rate the response with 5 STARS and provide some feedback as you see fit?

Cheers!

This query has required 35 minutes to research, investigate, and prepare a response.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi (0 minute later)
Brief Answer:
Thanks for the clarification on your dosing regimen.

Detailed Answer:
Ahhh....yes, you're correct....my bad. I thought it was 1 pill 3x/day. At any rate, the total daily dose still comes out to what I had thought....and the repetition of that dose 1 hr. later should not've caused a problem. The proof in that pudding is that at the time you were writing your 2nd response back....(17-18 hrs ago) you were not writing anything about adverse effects. I would've expected the negative things of having duplicated the dose to have shown themselves within several hrs. at most.

The fact that they didn't suggests to me that you're going to be OK.

As far as "skipping" a dose....that is really going to depend on what YOUR DOCTOR or NEUROLOGIST thinks about the situation. There are 2 ways to look at what happened. One would be to treat it AS IF you had been given a LOADING dose of the medication to start taking just to get your blood levels up to snuff a bit quicker. In that instance the patient would be expected to be taking their medications on a daily/nightly basis (however, prescribed) as ordered going forward, so missing the next night's dose would not be proper.

The 2nd way to look at it would be that since you doubled the dose so close together that your blood concentrations would go to a point whereby "skipping" a day might allow them to come back down to more "expected" levels for the dosing regimen you were given and so it would be OK to not take the dose the following day. The problem with that thought process is that blood concentrations are not known nor can they be accurately predicted by saying doubling the dose doubles the blood concentration so that skipping a day is going to correct that...it sounds logical to say that....but the way the body metabolizes medications is all be so predictable.

In my patients I much prefer they stick with the ordered schedule of daily/nightly dosings without missing and they simply fall into that habit, no mater whether they accidentally took an extra dose.

More of a concern to me in your case would be to understand how you could've made that error in the first place since the time between one dose and the duplicate was only 1 hr. Did you mix the pills up thinking they were some other medication? Or how did it actually happen. To me that's a more important detail to ferret out right now so that it doesn't happen again.

Skipping or not skipping the dose on your Keppra needs to be a decision that your doctor makes. I cannot speak for them. I would therefore, strongly recommend you place a call to their office and report the incident and find out how they wish you to proceed. I guarantee they will not be happy if I recommend something not in accordance with their thinking and that you decided to take my advice as opposed to calling them to get a clarification.

I will make one comment about the dosing of once daily of 1500mg. for whatever your condition may be....to let you know that the more commonly way to prescribe this medication is TWICE daily. So that if your doctor wanted you to take a total of 1500mg. in 1 day it would be more commonplace to order 750mg. twice daily. Again, the rationale for saying this is in the way the drug is manufactured, formulated, and eliminated from the body. If you only take the drug once daily then, what could happen is that you may get a large spike of medication in your bloodstream within an hr. or 2 but because of elimination kinetics...that drug may be virtually cleared in 20 hrs. at most...and certainly by 24 hrs. when your next dose is due...you'll have relatively low levels in the bloodstream....as opposed to taking the drug twice daily in which case there would be a smoother decline of the medication by metabolism and your body would not experience those giants peaks and valleys during which time things may react or cause problems due to a relative lack of drug that is supposed to be covering you....for seizures maybe, or whatever condition they're treating..

And so, I would ask the doctor about the dosing of the medication as once daily since that it a bit different from how it is generally given.

So Let's recap everything for clarity. Here are my 3 recommendations:

1. Report what happened to your doctor right now...call their office, they've got to have someone on call for the practice that can answer this question (either the doctor, an NP/PA, or another doctor covering).

2. Allow them to make the decision as to whether or not you should take the daily dosing on schedule despite the duplication of medication. (In my patients, if I were treating someone for seizure/epilepsy...I would most likely tell them to stay on schedule with their upcoming dose and not skip anything based on what happened).

3. Correct whatever happened that allowed you to duplicate that medication dose so close to when you took the first dose (alarm clock pill box, more clear labeling of medication bottles, etc).

If I've answered your questions satisfactorily would you be so kind as to CLOSE THE QUERY and rate the response with 5 STARS and provide some feedback as you see fit?

Cheers!

This query has required 35 minutes to research, investigate, and prepare a response.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

premium_optimized

The User accepted the expert's answer

Share on
I take levetiracetam er 500 mg/3 per day. I took

I take levetiracetam er 500 mg/3 per day. I took the three and an hour later accidentally took 3 more. Should I be concerned?