Recommended Levetiracetam (Keppra) Loading Dose
The recommended loading dose for Keppra (levetiracetam) in status epilepticus is 30-60 mg/kg IV (maximum 4500 mg), administered at a rate of 100 mg/min. 1
Adult Loading Dose Recommendations
- For status epilepticus in adults, a loading dose of 30-50 mg/kg IV at a rate of 100 mg/min is recommended 1
- Typical fixed dosing in adults is 1500-3000 mg IV 1, 2
- Maximum recommended loading dose is 4500 mg 3
- Infusion can be administered as:
Pediatric Loading Dose Recommendations
- For status epilepticus in children: 20-30 mg/kg IV (maximum 1000 mg per dose) 1
- For neonates with status epilepticus: 10 mg/kg IV 1
- Recommended infusion time is 10-20 minutes in pediatric patients 1
Administration Considerations
- IV push administration significantly reduces time to administration compared to IV piggyback (12 min vs. 38-44 min) 5, 4
- Faster administration may be particularly beneficial in status epilepticus 5
- Administration rate should not exceed 100 mg/min to minimize adverse effects 1
Efficacy and Safety
- Higher doses (≥40 mg/kg) do not appear to provide additional seizure control benefit compared to moderate doses (21-39 mg/kg) 3
- Loading doses ≥40 mg/kg are associated with higher rates of intubation (45.8%) compared to lower doses (26.8-28.2%) 3
- Common adverse effects include somnolence, asthenia, and dizziness; these tend to increase with higher doses 6, 2
- Levetiracetam has a favorable safety profile with minimal cardiac effects compared to other antiseizure medications 1
Oral Loading
- When IV access is not available, oral loading with 1500 mg as a single dose can achieve therapeutic levels within 1-2 hours 2
- Oral loading is generally well-tolerated with minimal side effects 2
- Maintenance dosing can begin 12 hours after oral loading at 500-1000 mg twice daily 2
Clinical Pearls
- Levetiracetam is considered a second-line agent after benzodiazepines for status epilepticus 1
- Therapeutic serum levels can be achieved within minutes of IV administration 2
- Unlike phenytoin/fosphenytoin, levetiracetam does not require cardiac monitoring during administration 1
- Levetiracetam has minimal drug interactions, making it suitable for patients on multiple medications 1
- Consider lower doses in patients with significant renal impairment 4