What is the recommended dosage of Keppra (levetiracetam) for seizure treatment?

From the Guidelines

The recommended dosage of Keppra (levetiracetam) for seizure treatment is 1,500 mg oral load, with rapid IV loading safe and well tolerated in doses up to 60 mg/kg, as supported by the study published in the Annals of Emergency Medicine 1. When considering the treatment of seizures with Keppra, it's essential to weigh the benefits and risks, prioritizing morbidity, mortality, and quality of life. The dosage of Keppra can vary depending on the patient's response and seizure control.

• Key points to consider when prescribing Keppra include:
  • The initial oral load of 1,500 mg, as mentioned in the study 1
  • The potential for rapid IV loading, which is safe and well-tolerated in doses up to 60 mg/kg
  • The importance of monitoring patients for side effects, such as fatigue, dizziness, and pain at the infusion site
  • The need for regular monitoring by a healthcare provider to ensure optimal dosing and management of potential side effects In clinical practice, the choice of administration route (oral versus parenteral) is at the discretion of the emergency physician, as there is a lack of evidence to support one route over the other in terms of preventing early recurrent seizure, as noted in the study 1.
• Factors to consider when selecting a dosage regimen include:
  • Patient age and weight
  • Renal function and potential need for dose adjustment
  • History of adverse effects or interactions with other medications
  • The need for consistent dosing and potential consequences of abrupt discontinuation By prioritizing the most recent and highest-quality evidence, healthcare providers can make informed decisions about Keppra dosing, minimizing the risk of adverse effects and optimizing seizure control, as supported by the study published in the Annals of Emergency Medicine 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Levetiracetam is indicated as adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. Partial Onset Seizures Adults 16 Years And Older In clinical trials, daily doses of 1000 mg, 2000 mg, and 3000 mg, given as twice-daily dosing, were shown to be effective Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) Additional dosing increments may be given (1000 mg/day additional every 2 weeks) to a maximum recommended daily dose of 3000 mg. Pediatric Patients Ages 4 To <16 Years Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID). The daily dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID).

The recommended dosage of Keppra (levetiracetam) for seizure treatment is:

• For adults 16 years and older: 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with a maximum recommended daily dose of 3000 mg.
• For pediatric patients ages 4 to <16 years: 20 mg/kg/day to 60 mg/kg/day, given as twice-daily dosing, with a maximum recommended daily dose of 60 mg/kg/day 2. Key points:
• The dosage should be initiated at 1000 mg/day for adults and 20 mg/kg/day for pediatric patients.
• The dosage can be increased every 2 weeks by increments of 1000 mg/day for adults and 20 mg/kg/day for pediatric patients.
• The maximum recommended daily dose is 3000 mg for adults and 60 mg/kg/day for pediatric patients.

From the Research

Keppra Dosage for Seizure Treatment

The recommended dosage of Keppra (levetiracetam) for seizure treatment varies depending on the type and severity of the seizures, as well as the patient's age and medical history.

• The dosage of Keppra is not explicitly stated in the provided studies, however, the efficacy and safety of levetiracetam in controlling seizures has been established in numerous randomized, double-blind, controlled, multicentre trials in patients with epilepsy 3, 4.
• Levetiracetam is indicated for the adjunctive treatment of partial-onset seizures in adults and children, and of myoclonic and primary generalized tonic-clonic seizures in patients with idiopathic generalized epilepsy 5, 6.
• A meta-analytic evaluation of the efficacy and safety of levetiracetam for treating myoclonic seizures found that 59.72% of patients with myoclonic seizures significantly responded to levetiracetam, and 37.82% became seizure-free after treatment 7.

Administration and Pharmacokinetics

• Levetiracetam is associated with rapid and complete absorption, high oral bioavailability, minimal metabolism, and primarily renal elimination 3, 4.
• It lacks cytochrome P450 isoenzyme-inducing potential and is not associated with clinically significant pharmacokinetic interactions with other drugs, including other antiepileptic drugs 3, 4.
• New formulations of levetiracetam, including intravenous infusion and extended-release once-daily tablets, have been compared with immediate-release tablets and oral solution, and can be used interchangeably 5.

Efficacy and Safety

• The efficacy of oral immediate-release levetiracetam in controlling seizures has been established in numerous randomized, double-blind, controlled, multicentre trials in patients with epilepsy 3, 4.
• Levetiracetam is not associated with cognitive impairment or drug-induced weight gain, but has been associated with behavioral adverse effects in some patients 3, 4.
• A meta-analytic evaluation found that levetiracetam significantly reduced the occurrence of myoclonic seizures, and is well-tolerated with few side-effects 7.