What is the loading dose of Keppra (levetiracetam)?

From the Guidelines

The loading dose of Keppra (levetiracetam) is 1,500 mg oral load, or up to 60 mg/kg IV loading dose, as evidenced by recent clinical guidelines. When considering the management of seizures, it is crucial to prioritize the most effective and safest approach to minimize morbidity, mortality, and improve quality of life. The choice of loading dose for levetiracetam is guided by the need for rapid attainment of therapeutic levels while minimizing adverse effects. Key considerations include:

• The oral loading dose of 1,500 mg is a straightforward approach for patients who can tolerate oral medication 1.
• For patients requiring intravenous administration, a dose of up to 60 mg/kg can be safely used, offering a rapid and effective means of achieving therapeutic levels 1.
• The selection of the loading dose should be individualized based on the patient's clinical status, the urgency of seizure control, and their ability to tolerate oral or intravenous therapy.
• It is essential to monitor patients closely for potential side effects, such as fatigue, dizziness, and rarely, pain at the infusion site, especially with intravenous administration 1.
• Maintenance dosing should be adjusted according to the patient's response and renal function, as levetiracetam is primarily excreted by the kidneys.
• The mechanism of action of levetiracetam, binding to the synaptic vesicle protein SV2A, underlies its efficacy in stabilizing neuronal membranes and inhibiting neurotransmitter release.
• Peak plasma concentrations are reached quickly, within 1 hour of oral administration and immediately after IV administration, with a half-life of 6-8 hours in patients with normal renal function, supporting the use of loading doses to rapidly achieve therapeutic levels.

From the FDA Drug Label

Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID)

The loading dose of Keppra (levetiracetam) is 1000 mg/day for adults, given as 500 mg BID, and 20 mg/kg/day for pediatric patients, given as 10 mg/kg BID 2.

From the Research

Loading Dose of Keppra (Levetiracetam)

• The loading dose of Keppra (levetiracetam) can vary depending on the clinical situation and patient population 3, 4, 5.
• In a case report, a patient with status epilepticus received a loading dose of 4 g of intravenous levetiracetam 3.
• A study on oral loading of levetiracetam used a single dose of 1,500 mg, followed by a maintenance dose of 500 to 1,000 mg twice a day 4.
• Another study evaluated the safety and efficacy of three loading doses of levetiracetam (≤20 mg/kg, 21-39 mg/kg, and ≥40 mg/kg) in adult patients with benzodiazepine-refractory status epilepticus, with a maximum dose of 4500 mg 5.
• The optimal loading dose of levetiracetam is not well established, and further research is needed to determine the most effective and safe dose 5.

Dosing Regimens

• Levetiracetam can be administered orally or intravenously, with dosing regimens varying from 1000 to 4000 mg per day 6, 7.
• A dose-escalation study found that levetiracetam was effective and well-tolerated at doses from 1000 to 4000 mg per day, with somnolence and asthenia being the most common adverse events 7.
• The dose-response effect of levetiracetam has been evaluated in several studies, with results suggesting that higher doses may be more effective in reducing seizure frequency 6, 7.