Levetiracetam (Keppra) Loading Dose
For status epilepticus, the recommended loading dose of levetiracetam is 30 mg/kg IV (maximum 2500 mg) administered at a rate of 5 mg/kg per minute. 1
Adult Loading Dose Recommendations
- Status epilepticus: 30 mg/kg IV (maximum 2500 mg) 1
- Administration rate: 5 mg/kg per minute 1
- Infusion time: Should be administered over a 15-minute IV infusion period 2
Pediatric Loading Dose Recommendations
- Children: 30-50 mg/kg IV administered over 10-15 minutes 1
- Caution: Doses above 20 mg/kg/day should be introduced carefully in children 1
Administration Considerations
Levetiracetam in Sodium Chloride Injection is available in three single-dose 100 mL bags with different concentrations:
- 500 mg (5 mg/mL)
- 1000 mg (10 mg/mL)
- 1500 mg (15 mg/mL) 2
The solution should be inspected visually for particulate matter and discoloration prior to administration. It should not be further diluted prior to use, and any unused portion should be discarded 2.
Special Populations
Renal Impairment
Levetiracetam dosing must be individualized according to renal function status since it is primarily cleared by the kidneys 2. For patients with moderate to severe renal impairment, dose adjustments are necessary 3.
Patients on CVVH
For patients receiving continuous venovenous hemofiltration (CVVH), a loading dose of 2000 mg may be appropriate, followed by maintenance doses of 1000 mg every 12 hours 4.
Efficacy and Safety
- Levetiracetam has an efficacy of 67-73% in controlling refractory status epilepticus 1
- A dose of 1500 mg has been found to resolve status epilepticus in 78% of patients within 30 minutes 1
- Approximately 89% of patients do not report significant adverse effects after the loading dose 1
Common Adverse Effects
- Somnolence (10.5-15.2%)
- Asthenia
- Dizziness
- Irritability 1
Important Considerations
- Behavioral adverse effects (irritability, agitation) occur in approximately 12-15% of patients, especially those with intellectual disability or psychiatric history 1
- Patients with a history of psychiatric disorders may require slower titration and closer monitoring 1
- Recent pharmacokinetic modeling suggests that weight-based loading doses of 40 mg/kg (up to a maximum of 4500 mg) may improve the likelihood of achieving sustained therapeutic drug concentrations 5, though this differs from the established guideline recommendation of 30 mg/kg (maximum 2500 mg) 1
Levetiracetam has a favorable pharmacokinetic profile with minimal protein binding, no hepatic metabolism, and limited drug interactions, making it a preferred choice for seizure management in many clinical scenarios 1, 3.