From the Guidelines
The recommended dose of Keppra (levetiracetam) for seizure prophylaxis is 30–50 mg/kg IV load at 100 mg/min, as indicated in the evidence from 1. When considering seizure prophylaxis, it's crucial to prioritize the most effective and safest option.
- The dose of 30–50 mg/kg IV load at 100 mg/min is specified for Keppra (levetiracetam) in the context of seizure management, as seen in 1.
- This recommendation is based on the provided evidence, which outlines various antiepileptic medications and their respective doses for seizure prophylaxis.
- It's essential to note that the evidence from 1 and 1 provides a comprehensive overview of antiepileptic medications, including their doses, adverse effects, and administration routes.
- However, for Keppra (levetiracetam) specifically, the dose of 30–50 mg/kg IV load at 100 mg/min is the recommended option for seizure prophylaxis, as it is directly mentioned in the evidence from 1.
- Common side effects of Keppra include nausea and rash, as indicated in 1.
- The mechanism of action of Keppra, binding to the synaptic vesicle protein SV2A, helps regulate neurotransmitter release and stabilize neuronal excitability, making it a useful option for patients who do not respond to or cannot tolerate other medications.
- It is also important to consider the potential for adverse effects, such as nausea and rash, and to monitor patients closely during treatment with Keppra.
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. 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 dose of Keppra (levetiracetam) for seizure prophylaxis is 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with a starting dose of 1000 mg/day and increments of 1000 mg/day every 2 weeks 2.
- Adults 16 years and older: 1000 mg/day to 3000 mg/day
- Pediatric patients:
- Ages 4 to <16 years: 20 mg/kg/day to 60 mg/kg/day
- Ages 6 to <16 years: 20 mg/kg/day to 60 mg/kg/day for primary generalized tonic-clonic seizures
- Ages 12 to <16 years: 1000 mg/day to 3000 mg/day for myoclonic seizures
From the Research
Levetiracetam Dosing for Seizure Prophylaxis
- The recommended dose of levetiracetam for seizure prophylaxis is not universally established, but studies suggest that a total daily dose (TDD) greater than 1000 mg may be more effective in reducing seizure incidence 3.
- A study found that patients receiving a TDD of 1000 mg had a higher seizure incidence than those receiving a TDD greater than 1000 mg, with no difference in adverse effects 3.
- Another study suggested that levetiracetam may be preferred for seizure prophylaxis post supratentorial neurosurgery, but the optimal dosing remains unclear 4.
- A retrospective review of pediatric patients with intracranial hemorrhage found that levetiracetam was a reasonable alternative to (fos)phenytoin for prophylaxis of early posthemorrhagic seizures, with no significant difference in late seizures 5.
- A pharmacokinetic study of levetiracetam in critically ill patients with severe traumatic brain injury suggested that regimens of 500 mg every 6 hours, 1000 mg every 8 hours, or 2000 mg every 12 hours may be required for optimal therapeutic target attainment 6.
- The efficacy of levetiracetam in reducing seizure frequency has been demonstrated in several clinical trials, with median percentage reductions ranging from 17.1% to 30.1% 7.
Dosage Regimens
- 500 mg every 6 hours 6
- 1000 mg every 8 hours 6
- 2000 mg every 12 hours 6
- Weight-tiered dosing regimens, with a 75 kg breakpoint, may be used to optimize levetiracetam therapeutic target attainment 6