From the Guidelines
When converting Levetiracetam (Keppra) from oral (PO) to intravenous (IV) administration, a dose of up to 60 mg/kg can be safely administered via rapid IV loading, but for standard conversion, a 1:1 dose conversion ratio can be used, as evidenced by the study published in the Annals of Emergency Medicine 1. For example, if a patient is taking 1000 mg of oral Keppra twice daily, they should receive 1000 mg of IV Keppra twice daily. Key points for implementation:
- Maintain the same dosing frequency when switching from PO to IV.
- Administer IV Keppra over 15 minutes.
- Monitor for side effects, particularly during the first few doses after conversion. The 1:1 conversion ratio is possible because levetiracetam has nearly 100% bioavailability when taken orally, as implied by the lack of specific conversion guidelines in the study 1. When switching back from IV to oral Keppra, use the same 1:1 ratio and maintain the same dosing schedule. Some important considerations:
- The study 1 provides information on the safety of rapid IV loading of levetiracetam, but it does not explicitly state the conversion ratio.
- However, given the high bioavailability of oral levetiracetam, a 1:1 conversion ratio is a reasonable approach.
- It is essential to monitor patients for side effects, particularly during the first few doses after conversion, to ensure a smooth transition between routes of administration.
From the FDA Drug Label
3 Switching to Intravenous Dosing When switching from oral levetiracetam, the initial total daily intravenous dosage of levetiracetam should be equivalent to the total daily dosage and frequency of oral levetiracetam.
4 Switching to Oral Dosing At the end of the intravenous treatment period, the patient may be switched to levetiracetam oral administration at the equivalent daily dosage and frequency of the intravenous administration.
The conversion of Levetiracetam (Keppra) from oral (PO) to intravenous (IV) administration is 1:1, meaning the initial total daily intravenous dosage should be equivalent to the total daily dosage and frequency of oral levetiracetam 2.
From the Research
Conversion of Levetiracetam from Oral to Intravenous Administration
- The conversion of Levetiracetam (Keppra) from oral (PO) to intravenous (IV) administration is based on the bioequivalence of the two formulations 3.
- A study found that single doses of levetiracetam 1,500 mg administered as a 15-minute IV infusion and as oral tablets were bioequivalent, with geometric mean IV/oral ratios of 92.2 (90 % CI, 89.0-95.6) for AUC and 103.7 (90% CI, 91.6-117.4) for C(max) 3.
- Another study evaluated the short-term tolerability of intravenously (IV)-infused levetiracetam as a substitute for the same oral dose and found that IV LEV appears to be a well-tolerated, practical alternative in patients with partial-onset seizures temporarily unable to take the drug orally 4.
- The IV formulation of levetiracetam can be directly converted from oral tablets, with a dose of 1,500 mg IV being equivalent to 1,500 mg PO 3, 4.