What is the recommended dosage and treatment regimen for Kepra (Levetiracetam) in seizures treatment?

Levetiracetam (Keppra) Dosage and Treatment Regimen for Seizures

For seizure treatment, levetiracetam should be initiated at 1000 mg/day (500 mg twice daily) for adults, with increases of 1000 mg/day every 2 weeks to a maximum recommended dose of 3000 mg/day. 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
• Administration: Can be taken with or without food 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 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/day every 2 weeks
• Recommended dose: 60 mg/kg/day (30 mg/kg twice daily)
• Weight-based dosing:
  • 20-40 kg: Start with 500 mg/day, target 1500 mg/day

  • 40 kg: Start with 1000 mg/day, target 3000 mg/day 1

Ages 6 to <16 years (Primary Generalized Tonic-Clonic Seizures)

• Initial dose: 20 mg/kg/day in 2 divided doses
• Titration: Increase by 20 mg/kg/day every 2 weeks
• Recommended dose: 60 mg/kg/day (30 mg/kg twice daily) 1

Status Epilepticus Management

For status epilepticus, levetiracetam can be administered intravenously:

• Loading dose: 30-50 mg/kg IV (maximum 2,500 mg)
• Maintenance dose: 15-30 mg/kg every 12 hours (maximum 1,500 mg per dose) 2

In the ESETT trial, levetiracetam showed similar efficacy to fosphenytoin and valproate for benzodiazepine-resistant status epilepticus, with approximately 47% of patients achieving seizure cessation 3, 2.

Efficacy and Safety Profile

• Levetiracetam has demonstrated efficacy in reducing seizure frequency in multiple clinical trials, with median percentage reductions of 17-30% over placebo 4
• Responder rates (≥50% reduction in seizure frequency) range from 20.8% to 39.6% across different doses 4
• Common adverse effects include:
  • CNS-related: somnolence, asthenia, headache, and dizziness
  • Minimal drug interactions (lacks cytochrome P450 enzyme induction)
  • No significant effects on cognitive function or weight 5, 6

Practical Considerations

• Levetiracetam has high oral bioavailability and minimal metabolism
• Primarily eliminated through renal excretion
• Minimal drug-drug interactions, making it suitable for patients on multiple medications 5, 6
• For oral loading in patients who missed doses, a safety study showed good tolerability with minimal adverse effects 3

Monitoring

• Regular follow-up every 3-6 months is recommended to assess:
  • Seizure control
  • Medication tolerability
  • Potential side effects 2
• Monitor for behavioral adverse effects, which can occur in some patients 5, 6

Levetiracetam's favorable pharmacokinetic profile, minimal drug interactions, and established efficacy make it a valuable option for seizure management across various seizure types and age groups.