Epilepsy is one of the five major neuropsychiatric disorders worldwide, primarily due to its high disability and mortality rates. Antiseizure medications (ASMs) are the first-line treatment for primary epilepsy. Levetiracetam (LEV), a broad-spectrum second ASM, has been approved for the treatment of focal seizures, as well as adjunctive therapy for myoclonic seizures and primary generalized tonic-clonic seizures. LEV stands out for its favorable tolerability and fewer side effects. However, therapeutic drug monitoring to establish safe and effective approaches for LEV personalized treatment in some certain populations such as newborns, children, pregnant women, patients with hepatic or renal impairment where adequate safety and pharmacokinetic data is lacking. In this review, we summarized the pharmacokinetic characteristics of LEV in different populations, aiming to provide up-to-date guidance for clinical medication. In adults with epilepsy, pharmacokinetic parameters and dosing regimens align with those of healthy adults. Conversely, newborns and young children with epilepsy may require higher doses compared to adult patients. For elderly patients, it is advisable to adjust the dosage based on their creatinine clearance considering the decline in renal function. In cases of isolated hepatic impairment, dose alteration may not be required; close renal function monitoring is recommended for patients with hepatorenal syndrome. Dose adjustments for patients experiencing renal insufficiency should be based on their creatinine clearance. Notably, both pregnancy status and body weight significantly influence LEV clearance. Understanding the pharmacokinetic profile of LEV across different patient groups aids in optimizing its use, ensuring safety and efficacy in clinical practice.