Levetiracetam (Keppra) Loading Dose
The recommended loading dose of Keppra (levetiracetam) is 30-50 mg/kg IV administered at a rate of 100 mg/min for seizure management. 1, 2
Dosing Details by Clinical Context
Status Epilepticus
- Loading dose: 30-50 mg/kg IV at 100 mg/min 1, 2
- Maximum single dose: Generally up to 4500 mg has been studied 3
- Can be administered over 5-15 minutes with minimal adverse effects 3
- Efficacy for terminating seizures: 44-73% when used as second-line therapy 2
Seizure Prophylaxis in Critical Care
- Higher dosing regimen preferred: 750-1000 mg twice daily 4
- Lower doses (500 mg twice daily) often fail to achieve therapeutic levels 4
- Target serum level: 12-46 μg/mL 4
- Higher doses (750-1000 mg twice daily) reduce seizure risk by 68% compared to lower doses 4
Oral Loading for Outpatient Setting
- Oral loading dose: 1500 mg as a single dose 5
- Maintenance dosing can begin 12 hours later at 500-1000 mg twice daily 5
- Achieves mean serum concentration of approximately 30 μg/mL within 1-2 hours 5
- Well-tolerated with minimal side effects (11% report mild transient symptoms) 5
Administration Considerations
IV Administration
- Can be administered undiluted via peripheral IV access 3
- Traditional administration rate: over 15 minutes
- Rapid infusion (over 5 minutes) appears safe and well-tolerated 3
- No significant cardiac or hemodynamic adverse effects reported 1
Advantages of Levetiracetam
- Minimal drug interactions 6
- No significant cardiac effects or hypotension 1, 2
- No requirement for therapeutic drug monitoring in most cases 6
- Rapid achievement of steady state (24-48 hours) 6
- Linear pharmacokinetics with proportional increases in plasma concentration with dose 6
Special Populations
Renal Impairment
- Dosage adjustment required as 66% is excreted unchanged in urine 6
- Clearance directly dependent on creatinine clearance 6
Pediatric Dosing
- For children 4-16 years: 20 mg/kg initial dose, can be titrated up to 60 mg/kg/day 7
- For children >16 years: Adult dosing applies 7
Elderly
- Longer elimination half-life (10-11 hours vs 6-8 hours in younger adults) 6
- May require dose adjustment based on renal function 6
Common Side Effects
- Fatigue, dizziness 1
- Rarely: pain at infusion site 1
- Somnolence and asthenia may increase with higher doses 8
Clinical Pearls
- Levetiracetam achieves therapeutic levels rapidly after loading dose
- Unlike phenytoin/fosphenytoin, it does not cause hypotension or cardiac arrhythmias 1, 2
- Bioavailability of oral formulation is >95%, making oral loading a viable option when IV access is not available 6
- No evidence of drug accumulation during multiple administration 6
Levetiracetam's favorable safety profile and minimal drug interactions make it an excellent choice for loading in various clinical scenarios, particularly when rapid seizure control is needed without the cardiovascular risks associated with other antiepileptic medications.