Recommended Dosage of Levetiracetam (Keppra) for Seizures
For adult patients with seizures, levetiracetam (Keppra) should be initiated at 1000 mg/day (500 mg twice daily) with incremental increases of 1000 mg/day every 2 weeks to a maximum recommended daily dose of 3000 mg. 1
Adult Dosing (16 years and older)
Partial Onset Seizures
- Initial dose: 1000 mg/day given as 500 mg twice daily
- Titration: Increase by 1000 mg/day every 2 weeks
- Maximum recommended dose: 3000 mg/day
- Higher doses (>3000 mg/day) have been used in open-label studies but without evidence of additional benefit 1
Myoclonic Seizures (12 years and older with juvenile myoclonic epilepsy)
- Initial dose: 1000 mg/day given as 500 mg twice daily
- Titration: Increase by 1000 mg/day every 2 weeks
- Recommended dose: 3000 mg/day
- Lower doses have not been adequately studied 1
Primary Generalized Tonic-Clonic Seizures
- Initial dose: 1000 mg/day given as 500 mg twice daily
- Titration: Increase by 1000 mg/day every 2 weeks
- Recommended dose: 3000 mg/day 1
Pediatric Dosing
Ages 4 to <16 Years (Partial Onset Seizures)
- Initial dose: 20 mg/kg/day in 2 divided doses (10 mg/kg twice daily)
- Titration: Increase by 20 mg/kg every 2 weeks
- Recommended dose: 60 mg/kg/day (30 mg/kg twice daily)
- Mean daily dose in clinical trials: 52 mg/kg 1
Ages 6 to <16 Years (Primary Generalized Tonic-Clonic Seizures)
- Initial dose: 20 mg/kg/day in 2 divided doses (10 mg/kg twice daily)
- Titration: Increase by 20 mg/kg every 2 weeks
- Recommended dose: 60 mg/kg/day (30 mg/kg twice daily) 1
Status Epilepticus Dosing
IV Loading Dose for Status Epilepticus
- 30-50 mg/kg IV at 100 mg/min 2
- For non-convulsive status epilepticus: 40 mg/kg (maximum 2,500 mg) IV bolus 2
- For convulsive status epilepticus: 40 mg/kg (maximum 2,500 mg) IV bolus 2
Maintenance Dosing After Status Epilepticus
- For non-convulsive status epilepticus: 15 mg/kg (maximum 1,500 mg) IV every 12 hours 2
- For convulsive status epilepticus: 30 mg/kg IV every 12 hours or increase prophylaxis dose by 10 mg/kg (to 20 mg/kg) IV every 12 hours (maximum 1,500 mg) 2
Special Considerations
Critically Ill Patients
- Higher doses (750-1000 mg twice daily) are more effective than lower doses (500 mg twice daily) in critically ill patients
- Higher doses are more than twice as likely to achieve target serum levels (12-46 μg/mL) and reduce seizure odds by 68% compared to lower doses 3
Renal Impairment
- Dose adjustments required for patients with renal impairment
- Maximum daily dose of 1000 mg for severe impairment (CrCl <30 mL/min)
- 500-1000 mg every 24h with 250-500 mg supplemental dose following dialysis for ESRD patients 4
Administration
- Can be given orally with or without food 1
- For oral loading, 1500 mg as a single dose has been shown to be well-tolerated and rapidly achieves therapeutic serum concentrations 5
Efficacy and Safety
- Dose-response relationship has been demonstrated, with higher doses providing greater seizure reduction 6
- Approximately 15% of patients taking 1000 mg/day and 20-30% of patients taking 3000 mg/day achieve ≥50% reduction in seizure frequency 6
- Most common adverse effects are somnolence and asthenia, which increase with higher doses 7
- Levetiracetam has a low incidence of hypotension and respiratory depression when given as an IV load 2