What is the recommended Keppra (levetiracetam) loading dose for a 17-year-old boy weighing 56 kg after a seizure?

From the Guidelines

The recommended Keppra (levetiracetam) loading dose for a 17-year-old boy weighing 56 kg after a seizure is 1,500 mg oral load or up to 60 mg/kg rapid IV loading. According to the study published in the Annals of Emergency Medicine 1, the loading dose and route of administration strategies for antiepileptic medications, including levetiracetam, are outlined in Table 2. The study suggests that a 1,500 mg oral load or rapid IV loading of up to 60 mg/kg is safe and well-tolerated for levetiracetam.

Key Considerations

• The loading dose should be administered as soon as possible after the seizure to rapidly achieve therapeutic levels in the blood.
• The choice of administration route (oral versus parenteral) depends on the discretion of the emergency physician, as there is a lack of evidence to support one route over the other in terms of preventing early recurrent seizure 1.
• Common side effects of levetiracetam include fatigue, dizziness, and rarely, pain at the infusion site.
• Renal function should be assessed, as dose adjustments may be necessary in patients with impaired kidney function, although this is less common in adolescents.

Administration and Monitoring

• The medication can be administered orally or intravenously, depending on the patient's condition and the physician's preference.
• Blood level monitoring is not routinely required for Keppra, unlike some other antiepileptic medications, which simplifies ongoing management.
• Following the loading dose, a maintenance regimen of 500-1,000 mg twice daily (1,000-2,000 mg/day total) would be appropriate, with adjustments based on clinical response and tolerability.

From the Research

Keppra Loading Dose for a 17-Year-Old Boy

The recommended Keppra (levetiracetam) loading dose for a 17-year-old boy weighing 56 kg after a seizure can be determined based on the available studies.

• The dose of levetiracetam can range from 20 mg/kg to 60 mg/kg up to a maximum dose of 4500 mg 2.
• A study on children with seizures suggests a safe and appropriate loading dose of 50 mg/kg 3.
• For the given patient, a 17-year-old boy weighing 56 kg, the loading dose would be:
  • 20 mg/kg: 20 mg/kg * 56 kg = 1120 mg
  • 50 mg/kg: 50 mg/kg * 56 kg = 2800 mg
  • 60 mg/kg: 60 mg/kg * 56 kg = 3360 mg
• It is essential to note that the optimal loading dose of levetiracetam in benzodiazepine-refractory status epilepticus is still being researched, and further studies are needed to determine the most effective dose 2.
• The administration method of levetiracetam, either intravenous push (IVP) or intravenous piggyback (IVPB), does not seem to affect the safety and efficiency of the loading dose significantly 4.

Considerations

• The patient's age and weight should be considered when determining the loading dose.
• The type and severity of the seizure, as well as any underlying medical conditions, should also be taken into account.
• It is crucial to monitor the patient's response to the loading dose and adjust the treatment plan as needed.
• The studies suggest that levetiracetam is generally well-tolerated, but potential side effects, such as sleepiness, fatigue, and restlessness, should be monitored 3.