From the Guidelines
Levetiracetam (Keppra) should be initiated at a dose of 500 mg twice daily for adults with epilepsy, with gradual titration up to an effective maintenance dose of 1000-3000 mg daily divided into two equal doses, as this dosing regimen has been shown to be effective in managing epilepsy with minimal side effects 1.
Key Considerations
- For children, dosing is weight-based, starting at 10 mg/kg twice daily and increasing to 20-60 mg/kg/day divided into two doses.
- Elderly patients or those with renal impairment may require lower doses, and dose adjustments should be made gradually under medical supervision.
- The medication should be taken consistently at the same times each day with or without food, and should never be stopped abruptly as this could trigger seizures.
Mechanism of Action and Side Effects
- Levetiracetam works by binding to the synaptic vesicle protein SV2A in the brain, which helps regulate neurotransmitter release and stabilize neuronal activity.
- Common side effects include somnolence, dizziness, and behavioral changes, and patients should be aware that levetiracetam may interact with other medications, so all healthcare providers should be informed about its use.
Monitoring and Interactions
- Blood level monitoring is not routinely required, but kidney function should be assessed periodically.
- A study by Ruegg et al 1 showed that levetiracetam was effective in stopping seizures in 67% of patients with refractory status epilepticus, and another study by Fattouch et al 1 found that levetiracetam was effective in reducing seizures in 89% of elderly patients with status epilepticus.
- However, the most recent and highest quality study by 1 provides the most up-to-date guidance on the dosing and administration of levetiracetam, and should be prioritized in clinical decision-making.
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). Myoclonic Seizures In Patients 12 Years Of Age And Older With Juvenile Myoclonic Epilepsy Treatment should be initiated with a dose of 1000 mg/day, given as twice-daily dosing (500 mg BID). Dosage should be increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg. Primary Generalized Tonic-Clonic Seizures Adults 16 Years And Older Treatment should be initiated with a dose of 1000 mg/day, given as twice-daily dosing (500 mg BID). Dosage should be increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg.
The recommended dosage and treatment protocol for Levetiracetam (Keppra) in managing epilepsy is as follows:
- Partial Onset Seizures:
- Adults (16 years and older): 1000 mg/day, given as twice-daily dosing (500 mg BID), with additional dosing increments of 1000 mg/day every 2 weeks to a maximum recommended daily dose of 3000 mg.
- Pediatric patients (4 to <16 years): 20 mg/kg/day in 2 divided doses (10 mg/kg BID), with daily dose increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID).
- Myoclonic Seizures:
- Patients (12 years and older) with juvenile myoclonic epilepsy: 1000 mg/day, given as twice-daily dosing (500 mg BID), with dosage increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg.
- Primary Generalized Tonic-Clonic Seizures:
- Adults (16 years and older): 1000 mg/day, given as twice-daily dosing (500 mg BID), with dosage increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg.
- Pediatric patients (6 to <16 years): 20 mg/kg/day in 2 divided doses (10 mg/kg BID), with daily dose increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID) 2.
From the Research
Recommended Dosage and Treatment Protocol for Levetiracetam (Keppra) in Managing Epilepsy
The recommended dosage and treatment protocol for Levetiracetam (Keppra) in managing epilepsy can be summarized as follows:
- Initial dosing: 250 mg twice daily for 2 weeks, followed by 500 mg twice daily 3
- Titration: The dose can be titrated in 500 mg increments to a maximum tolerated or effective dose 3
- Maximum dosage: 3000 mg/day within four weeks 4
- Maintenance dose: The median maintenance dose is 1000 mg/day, with a range of 500-3000 mg/day 3
Efficacy of Levetiracetam in Epilepsy Management
The efficacy of Levetiracetam in epilepsy management can be summarized as follows:
- Seizure freedom: Around half of the patients achieved seizure freedom on a median dose of 1000 mg/day 3
- Responder rate: A significantly greater responder rate was observed with the higher dose of 2000 mg/day compared to 1000 mg/day 5
- Reduction in seizure frequency: Both doses of 1000 mg/day and 2000 mg/day significantly decreased mean partial seizure frequency compared to placebo 5
Comparison with Other Antiepileptic Drugs
The comparison of Levetiracetam with other antiepileptic drugs can be summarized as follows:
- Equivalent efficacy: Levetiracetam and controlled-release carbamazepine produced equivalent seizure freedom rates in newly diagnosed epilepsy at optimal dosing 6
- Better tolerability: Levetiracetam had a lower withdrawal rate for adverse events compared to carbamazepine 6
Adverse Events and Tolerability
The adverse events and tolerability of Levetiracetam can be summarized as follows:
- Common adverse events: Somnolence, dizziness, infection, and asthenia 4
- Neuropsychiatric symptoms: Around 50% of patients who discontinued Levetiracetam due to side effects developed neuropsychiatric symptoms 3
- Withdrawal-related adverse events: No typical withdrawal-related adverse events or rebound phenomena were reported after withdrawal or down-titration 5