From the FDA Drug Label
DOSAGE AND ADMINISTRATION Levetiracetam is indicated as adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. Partial Onset Seizures Adults 16 Years And Older In clinical trials, daily doses of 1000 mg, 2000 mg, and 3000 mg, given as twice-daily dosing, were shown to be effective Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) Additional dosing increments may be given (1000 mg/day additional every 2 weeks) to a maximum recommended daily dose of 3000 mg. Pediatric Patients Ages 4 To <16 Years Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID). The daily dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID).
The normal dose of Keppra (levetiracetam) is:
- For adults 16 years and older: 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with a starting dose of 1000 mg/day (500 mg BID).
- For pediatric patients ages 4 to <16 years: 20 mg/kg/day to 60 mg/kg/day, given as twice-daily dosing, with a starting dose of 20 mg/kg/day (10 mg/kg BID) 1.
From the Research
The normal dose of Keppra (levetiracetam) for adults typically starts at 500 mg taken twice daily, with gradual increases up to a maintenance dose of 1000-1500 mg twice daily, as supported by the most recent and highest quality study 2. The maximum recommended daily dose is 3000 mg. For children, dosing is weight-based, usually starting at 10 mg/kg twice daily and increasing to 20-30 mg/kg twice daily, as confirmed by a study on the development of an integrated population pharmacokinetic model for oral levetiracetam in populations of various ages and ethnicities 2. Some key points to consider when prescribing Keppra include:
- Keppra is primarily eliminated by the kidneys, so dose adjustments are necessary for patients with renal impairment 2.
- The medication should be taken consistently at the same times each day to maintain stable blood levels.
- Keppra works by binding to the synaptic vesicle protein SV2A in the brain, which helps regulate neurotransmitter release and reduces abnormal electrical activity that causes seizures.
- Side effects may include drowsiness, dizziness, and behavioral changes, as reported in a study on the efficacy and tolerability of 1000-4000 mg per day of levetiracetam as add-on therapy in patients with refractory epilepsy 3.
- Abruptly stopping Keppra can trigger seizures, so any dose changes should be done gradually under medical supervision. It's also worth noting that oral loading of levetiracetam has been shown to be well-tolerated and can facilitate stabilization and discharge of patients in epilepsy monitoring units, as demonstrated in a study on the tolerability and efficacy of oral loading of levetiracetam 4. However, high-dose levetiracetam administration should be approached with caution, as there is limited data on its safety and efficacy, although a case report suggests that prolonged accidental high-dose levetiracetam administration may be safe in some cases 5.