What is the intravenous (IV) dose of Levetiracetam (Keppra) for pediatric patients?

From the Guidelines

The recommended intravenous (IV) levetiracetam dose for pediatric patients is 40 mg/kg (maximum 2,500 mg) as a bolus dose, in addition to a maintenance dose of 15 mg/kg (maximum 1,500 mg) every 12 hours. This dose is based on the most recent and highest quality study available, which provides guidelines for the management of pediatric patients with seizures 1. The study recommends a bolus dose of levetiracetam 40 mg/kg (maximum 2,500 mg) IV, followed by a maintenance dose of 15 mg/kg (maximum 1,500 mg) IV every 12 hours.

Some key points to consider when administering IV levetiracetam to pediatric patients include:

• The medication should be administered over 15 minutes to reduce infusion-related adverse effects
• Dose adjustments are required for patients with renal impairment
• The medication can be given without regard to meals and can be switched to oral formulation at the same dose when the patient is able to take medications by mouth
• Levetiracetam works by binding to the synaptic vesicle protein SV2A in the brain, modulating neurotransmitter release and helping to control abnormal electrical activity that causes seizures

It's worth noting that other studies have investigated the use of levetiracetam in pediatric patients, including a prospective open-label safety study that evaluated the rapid IV loading of levetiracetam in pediatric patients 1. However, the most recent and highest quality study available provides the dose recommendations outlined above.

In terms of specific dosing guidelines, the study recommends the following:

• For acute seizure management or status epilepticus, a loading dose of 40 mg/kg (maximum 2,500 mg) can be administered
• For maintenance dosing, 15 mg/kg (maximum 1,500 mg) every 12 hours can be used
• The maximum recommended daily dose is not explicitly stated, but the maintenance dose should not exceed 1,500 mg every 12 hours.

From the Research

Levetiracetam IV Dose for Pediatric Patients

• The recommended IV dose of levetiracetam for pediatric patients is 50 mg/kg, with a maximal dose of 2500 mg, administered over 15 minutes 2.
• A study found that this dose was well tolerated by patients and is a safe, appropriate loading dose 2.
• Another study used a mean dose of 29.4 mg/kg in pediatric patients with acute seizures or status epilepticus, with most patients receiving additional antiepileptic drugs to abort their seizure 3.
• A more recent study evaluated the safety and tolerability of undiluted levetiracetam at high doses (up to 4500 mg) in pediatric patients and found no increased incidence of adverse effects compared to diluted levetiracetam 4.

Age and Weight Considerations

• The age range of pediatric patients in the studies varied from 1 day to 17.8 years 3 and 1 day to 32.7 years 4.
• The weight range of pediatric patients in the studies varied from 1.97 kg to 97 kg 3 and 1 kg to 97 kg 4.
• One study found that children with established status epilepticus responded similarly to levetiracetam, fosphenytoin, and valproate, with treatment success in approximately half of patients, regardless of age group 5.

Administration and Efficacy

• Levetiracetam can be administered undiluted or diluted, with no significant difference in adverse effects 4.
• The efficacy of levetiracetam in pediatric patients with seizures or status epilepticus has been demonstrated in several studies, with response rates ranging from 44% to 52% 3, 5.
• The drug has been found to be well tolerated at the doses studied, with minor adverse effects such as sleepiness, fatigue, and restlessness 2, 3.