What is the typical Keppra (Levetiracetam) dose for seizures?

From the Guidelines

The typical Keppra (levetiracetam) dose for seizures is 1500 mg as an oral load, with maintenance doses adjusted as needed for seizure control, as supported by the most recent and highest quality study 1.

Key Considerations for Keppra Dosing

• The initial dose can be adjusted based on the patient's response and tolerance to the medication.
• For children, dosing is weight-based, and the medication should be taken consistently at the same times each day to maintain stable blood levels.
• Doses may need adjustment for patients with kidney impairment, as Keppra is cleared by the kidneys.
• The medication works by binding to a synaptic vesicle protein (SV2A) in the brain, which helps regulate neurotransmitter release and stabilize electrical activity in the brain.

Potential Side Effects and Interactions

• Side effects may include drowsiness, dizziness, and irritability.
• Patients should never stop taking Keppra abruptly, as this could trigger seizures; dose reductions should always be gradual under medical supervision.
• The medication can be taken with or without food, and missed doses should be taken as soon as remembered unless it's almost time for the next dose.

Additional Guidance from Recent Studies

• A study from 2019 1 recommends levetiracetam as an anti-seizure prophylaxis for patients receiving chimeric antigen receptor T cell therapy, with a dose of 10 mg/kg (up to a maximum of 500 mg per dose) every 12 hours for 30 days following infusion.
• Another study from 2019 1 suggests that levetiracetam is generally well-tolerated, with a minimal risk of adverse drug interactions, although dose adjustments might be necessary in the setting of renal dysfunction.

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 typical Keppra (Levetiracetam) dose for seizures is:

• For adults 16 years and older: 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with a starting dose of 1000 mg/day (500 mg BID).
• For pediatric patients ages 4 to <16 years: 20 mg/kg to 60 mg/kg, given as twice-daily dosing, with a starting dose of 20 mg/kg (10 mg/kg BID). 2

From the Research

Typical Keppra Dose for Seizures

The typical dose of Keppra (Levetiracetam) for seizures can vary depending on the patient population and the specific type of seizure disorder.

• For adults with refractory epilepsy, a dose range of 1000-4000 mg per day has been shown to be effective in reducing seizure frequency 3.
• In children with absence epilepsies, a lower dose of 10-20 mg/kg/day divided every 12 hours has been used, with some patients achieving seizure control at relatively low doses 4.
• For the prevention of busulfan-induced seizures in patients undergoing hematopoietic stem cell transplantation, a dose range of 500-1000 mg twice daily in adults and 10 mg/kg twice daily in children has been recommended 5.
• In pediatric patients with epilepsy, high oral doses of levetiracetam (up to 275 mg/kg/day) have been tolerated and effective in some cases, although adverse effects such as behavioral changes have been observed 6.
• A population pharmacokinetic analysis has suggested that a starting dose of 10 mg/kg twice daily in children can achieve similar blood concentrations to those observed in adults receiving the recommended starting dose of 500 mg twice daily 7.

Dosing Considerations

When determining the typical dose of Keppra for seizures, several factors should be considered, including:

• Patient age and weight
• Type and severity of seizure disorder
• Concomitant medications and potential drug interactions
• Individual patient response and tolerability
• Specific clinical context, such as prevention of busulfan-induced seizures or treatment of refractory epilepsy.