From the Guidelines
Yes, it is okay to give the Keppra (Levetiracetam) maintenance dose immediately after the loading dose.
Maintenance Dose Details
- The maintenance dose of levetiracetam is 15 mg/kg (maximum 1,500 mg) i.v. every 12 hours as stated in Algorithm A 1 or 30 mg/kg i.v. every 12 hours as an alternative in Algorithm B 1.
- It is essential to note that the loading dose of levetiracetam is 40 mg/kg (maximum 2,500 mg) i.v. bolus, which can be given in addition to the maintenance dose, as mentioned in both Algorithm A and Algorithm B 1.
- The decision to administer the maintenance dose immediately after the loading dose should be based on the patient's clinical status and the severity of the seizures, considering the guidelines provided for the management of status epilepticus in paediatric patients receiving chimeric antigen receptor T cell therapy.
Clinical Considerations
- The guidelines emphasize the importance of assessing circulation, airway, and breathing (CAB) and providing airway protection interventions, high-flow O2, and checking blood glucose levels before administering any medication, including levetiracetam 1.
- Continuous electroencephalography monitoring is recommended if seizures are refractory, as stated in Algorithm B 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Administration of Levetiracetam Maintenance Dose
- The study 2 investigated the tolerability and efficacy of oral loading of levetiracetam, where patients received 1,500 mg of LEV in a single dose, and LEV maintenance was begun 12 hours later at doses of 500 to 1,000 mg twice a day.
- There is no direct evidence in the provided studies to suggest that the maintenance dose should be given immediately after the loading dose.
- However, the study 3 administered a maintenance dose of 20mg/kg/dose BID immediately after a loading dose of 20 mg/kg/dose, but this was in the context of status epilepticus in children.
- The study 4 assessed four increasing dose regimens, including a loading dose followed by eight maintenance doses, but the maintenance doses were started after the loading dose, not immediately.
- The studies 5 and 6 focused on the safety and efficiency of high-dose undiluted intravenous push levetiracetam loading doses, but did not provide information on the timing of the maintenance dose.