What is the recommended dosage and frequency of Keppra (levetiracetam) for seizure treatment?

Keppra (Levetiracetam) Dosage and Frequency for Seizure Treatment

For adults with seizures, Keppra (levetiracetam) should be initiated at 1000 mg/day (500 mg twice daily), with increases of 1000 mg/day every 2 weeks to a maximum recommended dose of 3000 mg/day. 1

Adult Dosing Guidelines

Initial Treatment

• Starting dose: 1000 mg/day divided into two doses (500 mg twice daily)
• Titration: Increase by 1000 mg/day every 2 weeks as needed
• Maximum recommended dose: 3000 mg/day (1500 mg twice daily)
• Administration: Can be taken with or without food 1

Specific Seizure Types

1. Partial Onset Seizures (Adults ≥16 years):

   • Initial: 1000 mg/day (500 mg twice daily)
   • Maximum: 3000 mg/day (1500 mg twice daily) 1

2. Myoclonic Seizures (≥12 years with juvenile myoclonic epilepsy):

   • Initial: 1000 mg/day (500 mg twice daily)
   • Recommended: 3000 mg/day (1500 mg twice daily) 1

3. Primary Generalized Tonic-Clonic Seizures (Adults ≥16 years):

   • Initial: 1000 mg/day (500 mg twice daily)
   • Recommended: 3000 mg/day (1500 mg twice daily) 1

4. Status Epilepticus:

   • Loading dose: 30 mg/kg IV (maximum 2500 mg)
   • Administration rate: 5 mg/kg per minute 2
   • Maintenance: 30 mg/kg/day divided into two doses 3

Pediatric Dosing Guidelines

Children 4 to <16 Years

• Initial dose: 20 mg/kg/day divided into two doses (10 mg/kg twice daily)
• Titration: Increase by 20 mg/kg every 2 weeks
• Recommended dose: 60 mg/kg/day (30 mg/kg twice daily) 1
• For children ≤20 kg: Use oral solution
• For children >20 kg: Can use either tablets or oral solution 1

Status Epilepticus in Children

• Loading dose: 30-50 mg/kg IV over 10-15 minutes
• Maintenance: 30 mg/kg every 12 hours 3

Special Populations

Renal Impairment

Dose adjustments are required based on creatinine clearance:

• Creatinine clearance 50-80 ml/min: 500-1000 mg every 12 hours 3
• Further reductions may be necessary with more severe renal impairment

Monitoring and Safety

Common Side Effects

• Somnolence (10.5-15.2%)
• Asthenia
• Dizziness
• Irritability 3

Special Considerations

• Behavioral side effects (irritability, agitation) occur in approximately 12-15% of patients, especially those with intellectual disability or psychiatric history 3
• For patients with risk of behavioral side effects, consider slower titration and closer monitoring 3

Efficacy

• Levetiracetam has shown 67-73% efficacy in controlling refractory status epilepticus 2
• In clinical trials, 50.1% of patients had seizure frequency reduction of ≥50%, and 15.8% became seizure-free 4

Seizure Prophylaxis

• For patients at risk of seizures (e.g., brain tumors, CAR T-cell therapy): 500-750 mg orally every 12 hours for 30 days 2

Levetiracetam's favorable safety profile, minimal drug interactions, and effectiveness make it a preferred choice for many seizure types, particularly in patients receiving other medications or with comorbidities.