From the Guidelines
Keppra (levetiracetam) should be dosed at 1,500 mg oral load or up to 60 mg/kg IV in the emergency room for acute seizure treatment, as it has been shown to be safe and well-tolerated with no seizures within 24 hours of loading in some studies 1. When considering the treatment of seizures in the emergency room, the dosing of Keppra is crucial for effective management. The evidence suggests that a loading dose of 1,500 mg orally or up to 60 mg/kg IV can be used, with the IV route being rapid and well-tolerated 1.
- Key points to consider when dosing Keppra in the ER include:
- The medication can be administered orally or intravenously, depending on the patient's condition and the emergency physician's discretion.
- The loading dose is typically followed by a maintenance dose, although the exact maintenance dosing is not specified in the provided evidence.
- Keppra has a favorable safety profile, with common side effects including fatigue, dizziness, and rarely, pain at the infusion site 1.
- The medication does not require serum level monitoring, which can simplify its use in the emergency setting. It is essential to note that while the evidence provides guidance on the dosing of Keppra, the choice of administration route and the decision to load the medication should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Keppra Dosing for Seizure Treatment in the ER
- The dosing of Keppra (levetiracetam) for seizure treatment in the Emergency Room (ER) can vary depending on the patient's condition and the severity of the seizures.
- According to a study published in 2015 2, a loading dose of 2000 mg followed by a maintenance dose of 1000 mg every 12 hours may be effective for patients with new-onset seizures.
- Another study from 2008 3 found that oral loading of levetiracetam with a single dose of 1500 mg was well-tolerated and rapidly yielded serum concentrations thought to decrease seizure frequency.
- A more recent study from 2024 4 compared the rates of achievement of target serum levels and new onset seizure among patients who received low (500 mg bid) versus high (750-1000 mg bid) dose levetiracetam, and found that higher doses were more likely to lead to optimal drug levels and reduced the odds of seizure.
- A study protocol from 2021 5 describes a multicenter non-inferiority designed randomized control trial comparing levetiracetam with fosphenytoin as a second-line treatment for status epilepticus, with levetiracetam administered at a dose of 1000-3000 mg.
- In cases of overdose, levetiracetam has been reported to cause sedation and respiratory depression, but recovery is rapid with supportive care 6.
Dosage Recommendations
- For patients with new-onset seizures, a loading dose of 2000 mg followed by a maintenance dose of 1000 mg every 12 hours may be effective 2.
- For patients with status epilepticus, a dose of 1000-3000 mg may be used as a second-line treatment 5.
- Higher doses (750-1000 mg bid) may be more effective in achieving optimal drug levels and reducing the odds of seizure 4.