From the Guidelines
The recommended loading dose for Keppra (levetiracetam) is 1,500 mg oral load or up to 60 mg/kg rapid IV loading. This recommendation is based on the study published in the Annals of Emergency Medicine in 2014 1. The study provides a table outlining the loading dose and route of administration strategies for antiepileptic medications, including levetiracetam. According to the table, a 1,500 mg oral load or rapid IV loading up to 60 mg/kg is recommended for levetiracetam.
The choice of administration route, whether oral or intravenous, depends on the clinical situation and the discretion of the emergency physician. However, the study notes that rapid IV loading of levetiracetam is safe and well-tolerated in doses up to 60 mg/kg. Some key points to consider when administering the loading dose include:
- The oral loading dose is 1,500 mg
- The IV loading dose can be up to 60 mg/kg
- The loading dose allows for rapid achievement of therapeutic levels in emergency situations
- Side effects to monitor include fatigue, dizziness, and rarely, pain at the infusion site
It is essential to note that the information provided may not be consistent with FDA labeling, and the choice of administration route should be based on the individual patient's needs and the clinical situation. The study also highlights the lack of evidence to support one route of administration over the other in terms of preventing early recurrent seizure 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 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.
The recommended loading dose for Keppra (levetiracetam) is not explicitly stated in the drug label. Key points:
- The label mentions initiation of treatment with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID).
- It does not provide a specific loading dose. 2
From the Research
Keppra Loading Dose
- The recommended loading dose for Keppra (levetiracetam) is not universally agreed upon, but some studies provide insight into its usage.
- A case report published in 3 describes a patient who received 4 g of intravenous levetiracetam as a loading dose for status epilepticus, which led to acute kidney injury.
- Another study published in 4 describes a patient who received a loading dose of 2000 mg of intravenous levetiracetam, followed by a maintenance dose of 1000 mg every 12 hours, while undergoing continuous venovenous hemofiltration (CVVH) and venoarterial extracorporeal membrane oxygenation (ECMO).
- The study in 4 suggests that the initial levetiracetam dose for patients receiving CVVH could be 1000 mg every 12 hours, with dosage adjustments based on therapeutic drug monitoring.
Considerations for Keppra Administration
- Levetiracetam is primarily excreted by the kidneys and requires dose adjustment according to the glomerular filtration rate 3.
- Clinicians should be aware of the potential for levetiracetam to cause acute kidney injury, especially when administered in high doses 3, 5.
- Monitoring kidney function is essential during levetiracetam treatment, especially in patients at high risk of kidney injury 6.