Usual Oral Dose of Keppra (Levetiracetam) for Long-term Use
The usual oral dose of Keppra (levetiracetam) for an adult patient who has been on it for 28 years is 1000-3000 mg per day, typically given as 500-1500 mg twice daily. 1
Dosing Guidelines for Adults
The FDA-approved dosing for levetiracetam in adults with epilepsy follows these parameters:
- Initial dose: 1000 mg/day (500 mg twice daily)
- Maintenance dose: 1000-3000 mg/day (500-1500 mg twice daily)
- Maximum recommended dose: 3000 mg/day 1
For a patient who has been stable on Keppra for 28 years, the dose would likely be within this therapeutic range, with the specific dose determined by:
- Seizure control effectiveness
- Tolerability of side effects
- Patient's renal function
Dosage Adjustments Based on Renal Function
For long-term users, renal function monitoring is important as dosage adjustments are required for patients with impaired renal function:
| Creatinine Clearance | Dosage (mg) | Frequency |
|---|---|---|
| >80 mL/min (Normal) | 500-1500 | Every 12h |
| 50-80 mL/min (Mild) | 500-1000 | Every 12h |
| 30-50 mL/min (Moderate) | 250-750 | Every 12h |
| <30 mL/min (Severe) | 250-500 | Every 12h |
| ESRD using dialysis | 500-1000 | Every 24h* |
*A 250-500 mg supplemental dose is recommended following dialysis 1
Administration Considerations
- Levetiracetam can be taken with or without food 1
- Only whole tablets should be administered
- For patients unable to swallow tablets, an oral solution is available
Monitoring for Long-term Users
For patients on long-term levetiracetam therapy like someone who has been taking it for 28 years:
- Regular assessment of seizure control
- Monitoring for adverse effects (most common: somnolence, asthenia, dizziness)
- Periodic assessment of renal function, especially in older adults
- No specific blood level monitoring is required as levetiracetam has a wide therapeutic window
Common Side Effects to Monitor
Even after long-term use, patients should be monitored for:
- Somnolence
- Dizziness
- Fatigue
- Behavioral changes (irritability, aggression)
Important Considerations
Effectiveness: Doses greater than 3000 mg/day have been used in open-label studies for periods of 6 months and longer, but there is no evidence that doses greater than 3000 mg/day confer additional benefit 1
Withdrawal: Abrupt discontinuation should be avoided to prevent increased seizure frequency. If discontinuation is needed, gradual dose reduction is recommended.
Long-term safety: Levetiracetam has a favorable long-term safety profile with minimal drug interactions, making it suitable for extended use 2
For a patient who has been stable on levetiracetam for 28 years, maintaining the current effective dose is generally recommended unless there are changes in renal function, tolerability issues, or breakthrough seizures that warrant dose adjustment.