What is the recommended treatment and dosage for Levetiracetam (Keppra) in patients with seizures?

From the Guidelines

Levetiracetam (Keppra) should be initiated at a dose of 10 mg/kg every 12 hours for 30 days following infusion, up to a maximum of 500 mg per dose, for patients receiving CAR T cell therapy with CNS disease or a history of seizures. The recommended treatment and dosage for Levetiracetam (Keppra) in patients with seizures can vary depending on the specific context and patient population.

• For adults with seizures, Levetiracetam is typically initiated at 500 mg twice daily, with gradual titration up to an effective maintenance dose of 1000-1500 mg twice daily based on clinical response 1.
• For children, dosing is weight-based, starting at 10 mg/kg twice daily and increasing to 20-30 mg/kg twice daily.
• Elderly patients or those with renal impairment require dose adjustments, with reductions of 50-80% recommended for patients with creatinine clearance below 50 mL/min.
• In the context of CAR T cell therapy, Levetiracetam is recommended as anti-seizure prophylaxis at a dose of 10 mg/kg every 12 hours for 30 days following infusion, up to a maximum of 500 mg per dose, for patients with CNS disease or a history of seizures 1. The medication works by binding to synaptic vesicle protein SV2A in the brain, modulating neurotransmitter release and stabilizing neuronal activity, making it effective for partial-onset, myoclonic, and generalized tonic-clonic seizures with a favorable safety profile and minimal drug interactions. Some key points to consider when using Levetiracetam include:
• The medication should be taken consistently at the same times each day, with or without food.
• It should never be stopped abruptly, as this may trigger seizures.
• Side effects include somnolence, dizziness, and behavioral changes, which patients should be monitored for.
• Dose adjustments may be necessary in patients with renal dysfunction. Overall, Levetiracetam is a effective and well-tolerated medication for the treatment of seizures, and its use should be tailored to the individual patient's needs and medical history.

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 treatment and dosage for Levetiracetam (Keppra) in patients with seizures is as follows:

• Adults 16 years and older:
  • Initial dose: 1000 mg/day, given as twice-daily dosing (500 mg BID)
  • Maximum recommended daily dose: 3000 mg
• Pediatric patients ages 4 to <16 years:
  • Initial dose: 20 mg/kg in 2 divided doses (10 mg/kg BID)
  • Maximum recommended daily dose: 60 mg/kg (30 mg/kg BID) 2

From the Research

Recommended Treatment and Dosage for Levetiracetam (Keppra) in Patients with Seizures

• The recommended starting dosage for Levetiracetam is 500 mg twice daily, with a maximum dosage of 3000 mg/day within four weeks 3.
• For patients with partial-onset epilepsy, Levetiracetam has been shown to be effective as an adjunctive treatment, with a dose-response effect observed at 1000 and 2000 mg/day 4.
• In patients with seizure prophylaxis in neurocritical care, a total daily dose (TDD) of >1000 mg may be more effective in reducing seizure incidence than a TDD of 1000 mg 5.
• The administration of Levetiracetam can be 500 mg twice daily for patients receiving a 1000-mg TDD, and 1000 mg twice daily for patients receiving >1000-mg TDD 5.

Efficacy and Tolerability of Levetiracetam

• Levetiracetam has been shown to be effective in reducing seizure frequency in patients with partial-onset epilepsy, with a significant dose-response effect observed at 1000 and 2000 mg/day 4.
• Levetiracetam has been compared to controlled-release carbamazepine in newly diagnosed epilepsy, with equivalent seizure freedom rates observed at optimal dosing 6.
• The most commonly reported adverse effects of Levetiracetam include somnolence, dizziness, infection, and asthenia 3, 4.

Special Considerations

• In patients with supratentorial neurosurgical diseases, Levetiracetam may be preferred for seizure prophylaxis compared to other antiseizure medications 7.
• The use of Levetiracetam in patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH) is not supported by significant reductions in seizure incidence, although more high-quality randomized trials are warranted 7.