Recommended Dosage of Levetiracetam (Keppra) for Pediatric Patients
For pediatric patients with epilepsy, levetiracetam should be dosed at 20 mg/kg/day initially, divided into two doses (10 mg/kg twice daily), with titration every 2 weeks by increments of 20 mg/kg/day up to a recommended daily dose of 60 mg/kg/day (30 mg/kg twice daily). 1
Age-Specific Dosing Guidelines
Children 4 to <16 Years (Partial Onset Seizures):
- Initial dose: 20 mg/kg/day divided into two doses (10 mg/kg BID)
- Titration: Increase by 20 mg/kg/day every 2 weeks
- Target dose: 60 mg/kg/day (30 mg/kg BID)
- Mean effective dose in clinical trials: 52 mg/kg/day 1
Children 6 to <16 Years (Primary Generalized Tonic-Clonic Seizures):
- Same dosing regimen as above
- The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied 1
Adolescents 12 Years and Older (Myoclonic Seizures):
- Initial dose: 1000 mg/day (500 mg BID)
- Titration: Increase by 1000 mg/day every 2 weeks
- Target dose: 3000 mg/day
- The effectiveness of doses lower than 3000 mg/day has not been studied 1
Weight-Based Dosing Guide
For children >20 kg, tablets can be used according to this weight-based guide:
| Patient Weight | 20 mg/kg/day (BID dosing) | 40 mg/kg/day (BID dosing) | 60 mg/kg/day (BID dosing) |
|---|---|---|---|
| 20.1 to 40 kg | 500 mg/day (1 × 250 mg BID) | 1000 mg/day (1 × 500 mg BID) | 1500 mg/day (1 × 750 mg BID) |
| >40 kg | 1000 mg/day (1 × 500 mg BID) | 2000 mg/day (2 × 500 mg BID) | 3000 mg/day (2 × 750 mg BID) |
For children ≤20 kg, oral solution should be used with the following calculation:
- Total daily dose (mL/day) = Daily dose (mg/kg/day) × patient weight (kg) ÷ 100 mg/mL 1
Administration Considerations
- Levetiracetam can be given orally with or without food 1
- A calibrated measuring device should be used for oral solution administration
- Only whole tablets should be administered when using tablet formulation 1
Special Populations
Patients with Renal Impairment
- Dosing must be individualized according to renal function status
- For pediatric patients with impaired renal function, follow adult dosing adjustment guidelines based on creatinine clearance 1
Safety and Efficacy Considerations
- Higher doses up to 275 mg/kg/day have been used in some pediatric patients with refractory epilepsy, with 44% achieving >50% reduction in seizure frequency 2
- The most common adverse effects are somnolence, asthenia, headache, and dizziness 3
- Behavioral side effects may occur in approximately 12% of pediatric patients on high doses 2
Practical Recommendations
- Start with the recommended initial dose of 20 mg/kg/day
- Monitor for clinical response and adverse effects during titration
- If seizures are not adequately controlled at 60 mg/kg/day, doses up to 146 mg/kg/day (median in high-dose studies) may be considered under close supervision 2
- For seizure prophylaxis in specific situations (e.g., busulfan-induced seizures during stem cell transplantation), 10 mg/kg twice daily has been shown to be effective 4
Levetiracetam is generally well-tolerated in the pediatric population, with a favorable side effect profile compared to many other antiepileptic medications and minimal drug interactions, making it a valuable option for treating various seizure types in children.