From the Guidelines
The recommended therapeutic level for Keppra (levetiracetam) is achieved with a loading dose of 1,500 mg oral load, with rapid IV loading safe and well tolerated in doses up to 60 mg/kg, as supported by studies such as 1.
Key Considerations
- The therapeutic level is typically considered effective for seizure control in most patients with epilepsy when the loading dose is administered.
- Dosing may vary depending on individual patient needs, with some patients requiring higher or lower doses to achieve optimal seizure control.
- Blood level monitoring is not routinely required for Keppra due to its wide therapeutic window, minimal protein binding, and linear pharmacokinetics, as noted in the context of antiepileptic medication management 1.
Administration and Monitoring
- Oral and IV formulations of Keppra are available, with the choice of administration depending on the clinical scenario and patient needs.
- Monitoring for adverse effects, such as fatigue, dizziness, and pain at the infusion site, is essential when administering Keppra, especially during the loading phase 1.
- Individual response to Keppra may vary, and treatment should be guided primarily by clinical response rather than solely by serum concentrations.
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.
The recommended therapeutic level for Keppra (levetiracetam) is a maximum daily dose of 3000 mg for adults 16 years and older, given as twice-daily dosing.
- The dose should be initiated at 1000 mg/day and increased by 1000 mg/day every 2 weeks.
- For pediatric patients, the daily dose should be 20 mg/kg to 60 mg/kg, given as twice-daily dosing 2.
From the Research
Recommended Therapeutic Level for Keppra (Levetiracetam)
The recommended therapeutic level for Keppra (levetiracetam) can be determined based on several studies.
- The therapeutic range for levetiracetam is generally considered to be between 20-40 mg/L 3.
- A study on the efficacy and tolerability of 1000-4000 mg per day of levetiracetam as add-on therapy in patients with refractory epilepsy found that levetiracetam was effective in reducing seizure frequency at all doses tested, but somnolence and asthenia were more frequent at higher doses 4.
- Another study on the tolerability and efficacy of oral loading of levetiracetam found that a single dose of 1500 mg was well-tolerated and rapidly yielded serum concentrations thought to decrease seizure frequency 5.
- A comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy found that levetiracetam was effective in controlling seizures at doses of 500-1500 mg twice daily 6.
- A study on the measurement of levetiracetam drug levels to assist with seizure control and monitoring of drug interactions with other anti-epileptic medications found that therapeutic levetiracetam levels were associated with seizure freedom in patients with epilepsy 3.
Key Findings
- Levetiracetam is effective in reducing seizure frequency at doses between 1000-4000 mg per day 4.
- The therapeutic range for levetiracetam is between 20-40 mg/L 3.
- Levetiracetam can be loaded orally with a single dose of 1500 mg to rapidly achieve therapeutic serum concentrations 5.
- Levetiracetam is effective in controlling seizures in newly diagnosed epilepsy at doses of 500-1500 mg twice daily 6.