From the Guidelines
The recommended pre-operative loading dose of Keppra (levetiracetam) is 1,500 mg oral load, as this dose has been shown to be safe and effective in preventing seizures within 24 hours of loading 1.
Key Considerations
- The loading dose can also be administered intravenously, with rapid IV loading safe and well tolerated in doses up to 60 mg/kg 1.
- The choice of administration route (oral versus parenteral) is at the discretion of the physician, as there is a lack of evidence to support one route over the other in terms of preventing early recurrent seizure 1.
Important Details
- The oral loading dose of 1,500 mg has been studied and found to be effective in preventing seizures within 24 hours of loading, with minimal side effects such as fatigue, dizziness, and rarely pain at the infusion site 1.
- It is essential to note that the information provided may not be consistent with FDA labeling, and the choice of administration should be based on individual patient needs and clinical judgment 1.
Clinical Implications
- The use of Keppra (levetiracetam) as a pre-operative loading dose is a common practice, although there is a lack of evidence to support or refute this practice 1.
- The medication's favorable safety profile, minimal drug interactions, and rapid onset of action make it a preferred choice for neurosurgical procedures.
- Monitoring for breakthrough seizures and adverse effects is crucial, and the duration of perioperative prophylaxis should be individualized based on the specific surgical procedure and patient risk factors.
From the Research
Pre-operative Loading Dose of Keppra (Levetiracetam)
- The pre-operative loading dose of Keppra (levetiracetam) is not explicitly stated in the provided studies as they primarily focus on the treatment of status epilepticus and prevention of bleeding in surgery.
- However, study 2 mentions that the loading doses of levetiracetam in adult patients with benzodiazepine-refractory status epilepticus range from 20 mg/kg to 60 mg/kg up to a maximum dose of 4500 mg.
- Study 2 also evaluates the safety and efficacy of three loading doses of levetiracetam (≤20 mg/kg, 21-39 mg/kg, and ≥40 mg/kg) and finds that the loading dose does not result in a statistically significant difference in the rate of seizure termination at 60 min.
- It is essential to note that the provided studies do not directly address the pre-operative loading dose of Keppra (levetiracetam), and the information available is related to its use in treating status epilepticus.
Relevant Studies
- Study 2 provides information on the loading doses of levetiracetam used in adult patients with benzodiazepine-refractory status epilepticus.
- Other studies, such as 3, 4, and 5, compare the efficacy and safety of levetiracetam with other antiepileptic drugs in treating status epilepticus but do not provide specific information on pre-operative loading doses.
- Study 6 is unrelated to the use of levetiracetam and focuses on pharmacological interventions for preventing bleeding in people undergoing elective hip or knee surgery.