Levetiracetam (Levipil) Dosing for a 13-Year-Old Child Weighing 48 kg
For a 13-year-old child weighing 48 kg, the appropriate dose of Levipil (levetiracetam) is 1500 mg/day, administered as 750 mg twice daily.
Dosage Calculation Based on Weight
Levetiracetam dosing for children is primarily determined by weight, with FDA-approved guidelines providing clear recommendations:
- For children weighing >40 kg: 1500 mg/day (750 mg tablet BID) as the target dose for adjunctive therapy 1
- This dosing is appropriate for children aged 4-16 years with partial onset seizures, which aligns with this patient's age group
Dosing Protocol
Initial Dosing
- Start with 20 mg/kg/day in 2 divided doses (10 mg/kg BID)
- For a 48 kg child, this equals approximately 960 mg/day (480 mg BID)
Titration
- Increase dose every 2 weeks by increments of 20 mg/kg/day
- Target maintenance dose is 60 mg/kg/day (30 mg/kg BID)
- For a 48 kg child, the maximum target dose would be 2880 mg/day
- However, the FDA-approved tablet dosing guide recommends 1500 mg/day for children >40 kg during titration to 60 mg/kg/day 1
Administration
- Levetiracetam can be given with or without food
- For a 48 kg child, use 750 mg tablets twice daily
- Ensure whole tablets are administered
Evidence-Based Considerations
Efficacy
- Clinical trials have shown that levetiracetam is effective as adjunctive therapy in children with refractory epilepsy
- Studies demonstrate 51.5% of children achieve >50% seizure reduction after 26 weeks of treatment 2
- Approximately 27.3% of children become seizure-free for at least 4 weeks 2
Pharmacokinetics in Children
- Children have a 30-40% higher clearance rate compared to adults 3
- The half-life of levetiracetam in children is approximately 6.0 ± 1.1 hours 3
- A maintenance dose equivalent to 130-140% of the usual adult maintenance dose on a weight-normalized level is recommended 3
Monitoring and Safety Considerations
Common Side Effects
- Most common adverse effects include:
- Hyperactivity (48.5%)
- Somnolence (36.4%)
- Irritability (33.3%)
- Aggressive behavior (27.3%) 2
- Most side effects are mild in severity
Monitoring Parameters
- Regular assessment of seizure frequency and severity
- Monitoring for behavioral changes, particularly irritability or aggression
- No specific laboratory monitoring is required, though baseline complete blood count may be considered 4
Important Clinical Caveats
- If the child cannot tolerate the target dose of 60 mg/kg/day, the dose may be reduced
- In clinical trials, the mean daily dose was 52 mg/kg 1
- Retention rate is approximately 70% after 26 weeks of therapy 2
- Levetiracetam has shown efficacy in both partial and primary generalized seizures, with better response in partial seizures 2
- The recommended dose may need adjustment based on clinical response and tolerability
By following these dosing guidelines, the child should receive appropriate therapeutic levels of levetiracetam while minimizing the risk of adverse effects.