What is the appropriate dose of Keppra (levetiracetam) for a patient experiencing active seizures?

From the Guidelines

Recommended Dose of Keppra (Levetiracetam) for Active Seizures

The appropriate dose of Keppra (levetiracetam) for a patient experiencing active seizures is 1500 mg administered orally as a loading dose, with the option for rapid intravenous (IV) loading safe and well-tolerated in doses up to 60 mg/kg 1.

Administration and Monitoring

This dose can be given as a single oral load or through IV administration, with the choice of administration route at the discretion of the emergency physician, considering factors such as the patient's condition, the severity of seizures, and the potential for adverse effects 1. It's crucial to monitor the patient closely for signs of adverse effects, including fatigue, dizziness, and rarely, pain at the infusion site 1.

Clinical Considerations

In the context of status epilepticus, the use of levetiracetam, among other anticonvulsants, has been studied, showing cessation of seizures in roughly half of the patients receiving the medication 1. The primary safety outcomes, including life-threatening hypotension or cardiac arrhythmia, were not significantly different among the levetiracetam, fosphenytoin, and valproate groups 1.

Dosing Adjustments

The dose should be adjusted based on the patient's response and clinical judgment, exercising caution to avoid excessive sedation or other adverse effects. While specific dosing regimens such as 1000 mg to 3000 mg administered intravenously, given as a single dose or divided into two doses, are mentioned in guidelines, the evidence supports the use of a 1500 mg oral load or up to 60 mg/kg IV as a safe and effective initial approach for managing active seizures with levetiracetam 1.

From the FDA Drug Label

For intravenous infusion only (2.1) Do not dilute prior to its use (2.1) Administer dose-specific bag intravenously over 15-minutes (2.1) Initial Exposure to Levetiracetam Partial-Onset Seizures: Initial dose is 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to a maximum recommended dose of 1500 mg twice daily (2. 2). Myoclonic Seizures in Patients with Juvenile Myoclonic Epilepsy: Initial dose is 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to the recommended dose of 1500 mg twice daily. (2.2). Primary Generalized Tonic-Clonic Seizures: Initial dose is 500 mg twice daily. Increase by 500 mg twice daily every 2 weeks to the recommended dose of 1500 mg twice daily. (2. 2).

The appropriate dose of Keppra (levetiracetam) for a patient experiencing active seizures is:

• Initial dose: 500 mg twice daily for partial-onset seizures, myoclonic seizures in patients with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures.
• Dose increase: 500 mg twice daily every 2 weeks to a maximum recommended dose of 1500 mg twice daily for partial-onset seizures, and to the recommended dose of 1500 mg twice daily for myoclonic seizures and primary generalized tonic-clonic seizures. 2 2 2

From the Research

Appropriate Dose of Keppra (Levetiracetam) for Active Seizures

• The appropriate dose of Keppra (levetiracetam) for a patient experiencing active seizures can vary depending on several factors, including the patient's weight, renal function, and the severity of the seizures 3, 4, 5, 6, 7.
• Studies have shown that levetiracetam can be administered at a loading dose of 20-60 mg/kg, up to a maximum dose of 4500 mg, for the treatment of benzodiazepine-refractory status epilepticus 5.
• A study found that there was no difference in rates of seizure termination at 60 minutes among patients who received levetiracetam loading doses of ≤20 mg/kg, 21-39 mg/kg, or ≥40 mg/kg 5.
• However, the study also found that patients who received levetiracetam >40 mg/kg had a higher rate of intubation compared to those who received lower doses 5.
• Another study found that rapid administration of undiluted loading doses of levetiracetam up to 4500 mg is safe and tolerable 6.
• The administration of levetiracetam via intravenous push (IVP) has been shown to be a safe and effective method, resulting in a reduction in time to medication administration and a reduction in benzodiazepine use 4, 7.

Administration Methods

• Levetiracetam can be administered via intravenous push (IVP) or intravenous piggyback (IVPB) 4, 7.
• IVP administration has been shown to be faster and more efficient than IVPB administration, with a significant reduction in time to administration 4, 7.
• A study found that IVP administration of levetiracetam doses up to 2000 mg is a safe method of administration, resulting in a reduction of time to medication administration and a reduction of benzodiazepine use 7.

Special Considerations

• Patients with renal dysfunction may require dosage reductions to prevent accumulation of levetiracetam 3.
• The volume of distribution and clearance of levetiracetam in patients receiving continuous venovenous hemofiltration (CVVH) are similar to those of normal healthy patients, and an initial dose of 1000 mg every 12 hours may be considered, with dosage adjustments based on therapeutic drug monitoring 3.