What is the recommended administration method and dose for Levetiracetam?

From the Guidelines

Levetiracetam should be administered at a dose of 10 mg/kg, up to a maximum of 500 mg per dose, every 12 hours for 30 days following infusion, or through the CRES-risk period, as a prophylactic measure against seizures in patients receiving CAR T cell therapy. This recommendation is based on the most recent and highest quality study available, which suggests that levetiracetam is generally well-tolerated and has a minimal risk of adverse drug interactions 1. The study also notes that dose adjustments may be necessary in the setting of renal dysfunction.

• Key points to consider when administering levetiracetam include:
  • Oral or intravenous formulations are available, with the intravenous formulation administered at the same dose as the oral form
  • Dose adjustments are necessary for patients with renal impairment based on creatinine clearance
  • Common side effects include somnolence, dizziness, and behavioral changes
  • Levetiracetam works by binding to the synaptic vesicle protein SV2A in the brain, modulating neurotransmitter release and preventing seizure activity
  • The medication has a favorable pharmacokinetic profile with minimal drug interactions, making it suitable for many patients with epilepsy, including those taking other medications

In terms of administration method and dose, the recommended dose of levetiracetam is 10 mg/kg, up to a maximum of 500 mg per dose, every 12 hours 1. This dose can be adjusted based on the patient's renal function and other individual factors. It is also important to note that levetiracetam can be administered orally or intravenously, depending on the patient's needs and abilities.

• Additional considerations for patients receiving CAR T cell therapy include:
  • Close monitoring for signs and symptoms of cerebral oedema
  • Routine chemistry panels should be monitored more frequently (every 6-8 hours) and medications adjusted accordingly to prevent rebound cerebral oedema, renal failure, hypovolemia and/or hypotension, and electrolyte abnormalities
  • Neurology consultation should be considered if the patient develops grade 1 CRES or for specialized screening for papilloedema
  • Patients should be closely monitored for signs and symptoms of cerebral oedema and status epilepticus can be managed according to institutional guidelines.

From the FDA Drug Label

Levetiracetam is given orally with or without food. 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 administration method for Levetiracetam is orally with or without food. The recommended dose for:

• Adults 16 Years And Older is 1000 mg/day, given as twice-daily dosing (500 mg BID), with a maximum recommended daily dose of 3000 mg.
• Pediatric Patients Ages 4 To <16 Years is 20 mg/kg/day, given in 2 divided doses (10 mg/kg BID), with a maximum recommended daily dose of 60 mg/kg (30 mg/kg BID) 2 2.

From the Research

Administration Method and Dose for Levetiracetam

The administration method and dose for Levetiracetam can vary depending on the patient's condition and the purpose of the treatment. Here are some key points to consider:

• Levetiracetam can be administered orally or intravenously 3, 4, 5, 6.
• The starting dosage for adults is typically 500 mg twice a day, with a maximum dosage of 3000 mg/day within four weeks 3.
• For pediatric patients, the dose range is 10 to 20 mg/kg/day divided every 12 hours 4.
• In patients undergoing hematopoietic stem cell transplantation, Levetiracetam can be started from 6 to 24 hours before busulfan initiation and continued up to 24 to 48 hours after the last dose of busulfan, with a dose range of 500 to 1000 mg twice daily in adults and 10 mg/kg twice daily in children 4.
• In patients with acute liver dysfunction on continuous venovenous hemofiltration (CVVH), a regimen of 1000 mg twice daily may be considered as an empiric Levetiracetam regimen 6.
• For seizure prophylaxis following traumatic brain injury, different dosing strategies of Levetiracetam (≤ 1000 mg/day, 1500 mg/day, and ≥ 2000 mg/day) have been evaluated, but no statistically significant difference in the cumulative incidence of early posttraumatic seizures was found between these strategies 7.

Key Considerations

• The dose and administration method of Levetiracetam may need to be adjusted based on the patient's renal function, as the drug is primarily eliminated through the kidneys 3, 5, 6.
• Therapeutic drug monitoring may be necessary to ensure optimal dosing and minimize the risk of adverse effects 5, 6.
• The potential for interactions with other medications should be considered when using Levetiracetam, although the risk is generally minimal 3.