Can You Crush Keppra (Levetiracetam)?
In our latest question and answer, the pharmacist discusses whether or not Keppra (levetiracetam) tablets can be crushed.
Hi, my son takes Keppra and there are days when they really have trouble swallowing the pills. Can I just crush them and put them on food?
Oct 28, 2022- Keppra tablets should be swallowed whole and not crushed or split because the film coating masks an unpleasant taste and makes the tablets easier to swallow.
- Crushing Keppra XR will destroy its extended-release properties and cause the entire dose to be released at once, which could reduce effectiveness and increase side effects.
- If you have trouble taking Keppra tablets, ask your pharmacist about liquid formulations, fast-dissolving tablets, or compounded suspensions as alternatives.
Answer
Keppra (levetiracetam) tablets, both the immediate-release version and Keppra XR (extended-release), should not be split or crushed. They are to be swallowed whole.
This recommendation comes straight from the manufacturer:
KEPPRA tablets should be swallowed whole. KEPPRA tablets should not be chewed or crushed.
Why Can't Keppra Be Crushed?
Keppra tablets (immediate-release) are 'film-coated' and cutting, splitting, or crushing them will destroy this film-coating.
While there are a number of reasons why a manufacturer may decide to film-coat their tablets, the main reasons are for ease of swallowing and to mask an unpleasant taste.
In regard to Keppra, not only are the tablets large and hard to swallow, they have a very unpleasant taste to them. Crushing the tablets and sprinkling them onto food can make the food unpalatable. This can be an issue when trying to dose the medication in children.
Regarding Keppra XR, the extended-release version of Keppra, cutting or crushing these will ruin the extended-release properties of the drug, causing it to be released all at once (versus over an extended period of time as intended). This could decrease how well the drug works and increase the risk of side effects.
It is important to note that crushing the immediate-release tablets will not affect how they work or how the drug is absorbed. For this reason, it is not uncommon that Keppra is compounded by some pharmacies by crushing the tablets and creating a liquid suspension. I write more about this in the next section.
Alternatives To Crushing Keppra
Fortunately, you have a few options if the tablets aren't working out for you, as it is available in multiple different formulations, including:
- Spritam fast-dissolving tablets
- Keppra 100mg/mL solution
Additionally, as mentioned, some pharmacies can compound Keppra into a suspension in different concentrations than what is commercially available (100mg/mL is the only concentration of liquid commercially available). They can also add flavoring agents to improve the taste.
In one study, compounded Keppra suspension 50mg/mL was stable at both room temperature and under refrigeration for at least 90 days and represents an alternative option for those needing the drug.
Final Words
I hope you found this helpful and please reach back out anytime!
References & sources
Glossary — Terms in This Answer
- Film-coated
- A tablet covered with a thin protective layer that makes it easier to swallow and hides bad taste.
- Extended-release
- A medication formulation designed to slowly release the drug into your body over several hours instead of all at once.
- Immediate-release
- A medication that dissolves and enters your bloodstream quickly after you take it.
- Compounded
- A medication that a pharmacist specially prepares or mixes, often in a custom strength or form for an individual patient.
- Suspension
- A liquid medication in which solid particles are mixed throughout but not fully dissolved.
- Levetiracetam
- The generic name for the anti-seizure medication brand-named Keppra.
- Concentrations
- The amount of active medication dissolved in a specific volume of liquid.
- Stable
- Able to maintain its strength and effectiveness without breaking down over time.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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