From the FDA Drug Label
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 pediatric loading dose of Keppra (levetiracetam) is not explicitly stated in the provided drug label, but the initial dose is 20 mg/kg/day in 2 divided doses. However, this is not a traditional loading dose, but rather an initial dose. Key points:
- The initial dose is 20 mg/kg/day.
- It is given in 2 divided doses (10 mg/kg BID). 1
From the Research
The recommended pediatric loading dose of Keppra (levetiracetam) is 20-60 mg/kg administered intravenously, with a recent study suggesting that higher doses may be safe in certain situations 2. For acute seizure management, a loading dose of 40-60 mg/kg is commonly used, while for less urgent situations, 20-30 mg/kg may be appropriate. The medication should be infused over 15-30 minutes to minimize side effects. After the loading dose, maintenance therapy typically begins at 10-20 mg/kg twice daily (20-40 mg/kg/day total), with adjustments based on clinical response and tolerability. Dosing may need modification for patients with renal impairment. Common side effects include somnolence, fatigue, and behavioral changes, which should be monitored closely. Levetiracetam works by binding to the synaptic vesicle protein SV2A, modulating neurotransmitter release and stabilizing neuronal activity, making it effective for various seizure types in children. The medication has a favorable safety profile with minimal drug interactions, making it suitable for critically ill children or those on multiple medications. Some studies have reported that higher doses of levetiracetam may be safe and effective in certain situations, such as in patients with benzodiazepine-refractory status epilepticus 2. However, the optimal loading dose of levetiracetam in pediatric patients has not been established, and further research is needed to determine the safest and most effective dose. In general, the loading dose of levetiracetam should be individualized based on the patient's specific needs and medical condition, and should be administered under the guidance of a qualified healthcare professional. It is also important to note that levetiracetam has been shown to be well-tolerated and effective in pediatric patients with epilepsy, and has a favorable safety profile compared to other antiepileptic medications 3, 4. Overall, the use of levetiracetam in pediatric patients requires careful consideration of the potential benefits and risks, and should be guided by the latest clinical evidence and expert recommendations. Key points to consider when administering levetiracetam to pediatric patients include:
- The recommended loading dose is 20-60 mg/kg administered intravenously
- The medication should be infused over 15-30 minutes to minimize side effects
- Maintenance therapy typically begins at 10-20 mg/kg twice daily (20-40 mg/kg/day total)
- Dosing may need modification for patients with renal impairment
- Common side effects include somnolence, fatigue, and behavioral changes, which should be monitored closely.