Key takeaways
- Xcopri and Keppra are both brand-name medications prescribed for focal onset seizures in adults. Keppra is also approved to treat focal onset, myoclonic, and tonic-clonic seizures in adults and some children.
- Xcopri and Keppra cause similar side effects. However, Xcopri carries a risk of physical dependence, while Keppra does not.
- Xcopri may be more effective than Keppra for treating drug-resistant focal onset seizures, which are seizures that haven’t responded to other treatments.
This article explains the main similarities and differences between Xcopri and Keppra. If you’re considering taking one of these drugs, discussing this information with your doctor can help you decide whether one of these treatments may be right for you.
Note: For more comprehensive information about these two drugs, you can refer to our Xcopri and Keppra articles.
Key differences between Xcopri and Keppra
These are a few of the main differences between Xcopri and Keppra:
- Dosage: Some forms of Keppra are taken more often than Xcopri. (See the “Dosage, forms, and administration” section for details.)
- Conditions treated: Xcopri and Keppra are both used to treat focal onset seizures. Keppra can also be used in combination with other medications to treat myoclonic seizures and tonic-clonic seizures.
- Ages: Xcopri is currently only approved for use in adults, while Keppra is approved for use in adults and children.
- Dependence: Xcopri is a controlled substance with risks of misuse and dependence. Keppra does not have a risk of dependence. Misuse refers to taking a drug in a way other than how a doctor prescribes it. With dependence, your body needs the drug to function as usual.
Here’s information about the generic status for Xcopri and Keppra, as well as details on their active ingredients.
| Xcopri | Keppra | |
|---|---|---|
| Generic available | no | yes |
| Active ingredient | cenobamate | levetiracetam |
| Drug class | anticonvulsant (antiseizure medication) | anticonvulsant |
Xcopri and Keppra have been approved by the Food and Drug Administration (FDA) for the following uses.
- Xcopri and Keppra are FDA approved to treat:
- focal onset seizures in adults
- Keppra is also FDA approved to treat:
- focal onset seizures in children ages 1 month and older
- myoclonic seizures in adults and children ages 12 years and older
- tonic-clonic seizures in adults and children ages 6 years and older
Xcopri isn’t approved by the Food and Drug Administration (FDA) for use in children under 18 years of age.
The approved uses of Keppra in children depend on the form prescribed (see the “Dosage, forms, and administration” section for details).
Keppra is approved for the following uses:
- focal onset seizures in children ages 1 month and older
- myoclonic seizures in children ages 12 years and older
- tonic-clonic seizures in children ages 6 years and older
Keppra XR is approved to treat focal onset seizures in children ages 12 years and older. (XR means extended release, which means the medication is released slowly into the body over time.)
Your doctor will initially start Xcopri or Keppra treatment by prescribing a low dosage. They’ll adjust it over time to reach the right amount for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.
The following table highlights the recommended dosages and administration of Xcopri and Keppra for focal onset seizures in adults. Measurements are given in milligrams (mg).
| Xcopri for focal onset seizures | Keppra for focal onset seizures | |
|---|---|---|
| Forms | oral tablet | Keppra: oral tablet, oral solution Keppra XR: extended-release oral tablet |
| Strengths | • 12.5 mg • 25 mg • 50 mg • 100 mg • 150 mg • 200 mg | Keppra tablet: • 250 mg • 500 mg • 750 mg • 1000 mg Keppra solution: • 100 mg per milliliter (mL) Keppra XR tablet: • 500 mg • 750 mg |
| Dose | initial dose: 12.5 mg recommended dose: up to 200 mg | Keppra: • initial dose: 500 mg (1,000 mg per day) • recommended dose: up to 1,500 mg (3,000 mg per day) Keppra XR: • initial dose: 1,000 mg • recommended dose: up to 3,000 mg |
| Frequency | once daily | Keppra: twice daily Keppra XR: once daily |
| Given by | self | self |
For information about Keppra dosages for its other approved uses, including children’s dosages, see our Keppra dosage guide. To read more about Xcopri’s dosage recommendations, see our Xcopri dosage guide.
Xcopri and Keppra both treat focal onset seizures. These drugs can cause some of the same side effects, as well as different ones. Some of the side effects reported in clinical trials of these drugs are listed here.
For more details about the side effects of these two drugs, see our side effect articles about Xcopri and Keppra. You can also refer to the prescribing information for:
Mild side effects
The following table lists some of the more commonly reported mild side effects of Xcopri and Keppra. The table may also include mild side effects that are less common but you may have concerns about in some cases.
| Mild side effects | Xcopri | Keppra |
|---|---|---|
| dizziness | ✓ | ✓ |
| weakness | ✓ | |
| fatigue | ✓ | ✓ |
| headache | ✓ | ✓ |
| drowsiness | ✓ | ✓ |
| double vision | ✓ | ✓ |
| nausea or vomiting | ✓ | ✓ |
| decreased appetite | ✓ | ✓ |
| sore throat | ✓ | |
| abdominal pain | ✓ | ✓ |
These side effects may be temporary, lasting a few days to weeks. If the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.
Serious side effects
The following table lists reported serious side effects of Xcopri and Keppra.
| Serious side effects | Xcopri | Keppra |
|---|---|---|
| problems with coordination and balance | ✓ | ✓ |
| irregular heart rhythm | ✓ | |
| confusion or memory problems | ✓ | ✓ |
| changes in levels of certain blood cells, including white blood cells and red blood cells | ✓ | |
| suicidal thoughts or behaviors | ✓ | ✓ |
| serious skin reactions, such as drug reaction with eosinophilia and systemic symptoms | ✓ | ✓ |
| liver problems | ✓ | |
| unusual changes in behaviors or mental health, including psychotic symptoms | ✓ | ✓ |
| worsening seizures if the drug is suddenly stopped | ✓ | ✓ |
If you have serious side effects while using Xcopri or Keppra, call your doctor immediately. If the side effects feel life threatening or you believe you’re having a medical emergency, call 911 or your local emergency number right away.
Allergic reactionFor some people, Xcopri or Keppra can cause an allergic reaction.
In general, symptoms of an allergic reaction can be mild or serious.
Ways to manage
For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.
For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Xcopri or Keppra, your doctor may recommend taking a different medication instead.
Here are answers to some common questions about Xcopri and Keppra.
How long does it take for Xcopri and Keppra to start working?
Xcopri and Keppra start to work after your first dose, although Keppra may start working more quickly. This is because Xcopri requires a slow dose increase over several weeks to reduce the risk of side effects, so it takes longer to reach its full effectiveness. Your doctor will monitor you during treatment to check whether the drug is working to treat your condition.
Talk with your doctor if you have questions about what to expect with Xcopri or Keppra treatment.
Is there a risk of dependence with Xcopri or Keppra?
Studies suggest Xcopri may cause physical dependence and withdrawal. With dependence, your body relies on a drug to function as usual. Dependence is not the same as addiction. Dependence can happen with long-term use of many substances, including certain prescription drugs, even if you take the medication as prescribed.
Withdrawal symptoms are side effects that can occur when you stop taking a drug that your body has become dependent on. If you suddenly stop taking Xcopri, you may experience withdrawal symptoms. Examples of withdrawal symptoms include:
To end your Xcopri treatment, your doctor will slowly lower your dosage over time. Doing so can help reduce your risk of withdrawal symptoms after you stop taking Xcopri.
If you have withdrawal symptoms after you’ve stopped taking Xcopri, talk with your doctor. They can recommend ways to ease these symptoms.
Xcopri and Keppra are effective options to help treat focal onset seizures.
Review of studies: Xcopri and Keppra are both effective treatment options for focal onset seizures. A 2024 study suggests that Xcopri may be more effective than Keppra for people with drug-resistant focal onset seizures, which are seizures that haven’t responded to other treatments.
In the study, Xcopri had a higher 12-month retention rate compared with other seizure medications, including Keppra. This means more people continued treatment with Xcopri over time, likely due to its balance of effectiveness and side effects. These findings may help doctors choose the best treatment option for people whose seizures haven’t responded to other drugs. For more information, talk with your doctor.
Prescribing information: For details about how these drugs performed in clinical trials, see the prescribing information for Xcopri, Keppra, and Keppra XR. Keep in mind that trial results may not apply to your individual health situation.
Treatment guidelines: Another way to determine whether a drug is considered effective is to look at treatment guidelines. When an organization includes certain drugs in treatment guidelines, this means research has shown the drug to be safe and effective.
Keppra is recommended as a treatment option for people with focal onset seizures in guidelines from the American Academy of Neurology (AAN) and the American Epilepsy Society (AES).
Xcopri is approved by the Food and Drug Administration (FDA) for treating focal onset seizures in adults. It is not specifically mentioned in the 2018 AAN/AES treatment guidelines because it was approved after those guidelines were published. However, studies show that Xcopri is an effective option for adults with focal onset seizures.
How much Xcopri or Keppra costs depends on the treatment plan your doctor prescribes, your insurance plan, and your pharmacy.
Both Xcopri and Keppra are brand-name drugs. Keppra also comes in generic forms. Brand-name medications often cost more than generics. Talk with your doctor or pharmacist to learn about the generic forms of Keppra.
Xcopri and Keppra may not be right for you if you have certain medical conditions or other factors that affect your health. These drugs have some of the same precautions, but they also have different ones. Some of these precautions are mentioned here.
If any of the following medical conditions or other health factors are relevant to you, talk with your doctor before starting Xcopri or Keppra.
| Precaution | Xcopri | Keppra |
|---|---|---|
| if you’ve had an allergic reaction to the drug or any of its ingredients | ✓ | ✓ |
| if you’re pregnant or thinking about becoming pregnant | ✓ | ✓ |
| if you’re breastfeeding or thinking about breastfeeding | ✓ | ✓ |
| if you have a history of liver problems | ✓ | |
| if you have a history of kidney problems | ✓ | ✓ |
| if you have or have a history of mental health conditions, such as depression, mood disorder, or suicidal thoughts or behaviors | ✓ | ✓ |
| if you have a heart condition called familial short QT syndrome (a rare inherited condition that causes an irregular heart rhythm) | ✓ |
Note: For more comprehensive information about these drugs, you can refer to our Xcopri and Keppra overview articles.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
Switching between Xcopri and Keppra is possible.
Talk with your doctor if you’d like to know more about switching between Xcopri and Keppra. They can give you additional details and determine the treatment plan for your situation. Even if two drugs treat the same condition or are in the same drug class, your body can still respond to them differently.
It’s important that you do not stop, start, or switch any of your drug treatments without your doctor’s recommendation.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.