Levetiracetam (Keppra) Loading Dose Recommendations
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
- The administration rate should not exceed 100 mg/min to minimize adverse effects 1
- In clinical practice, doses of 1500 mg as a single oral loading dose have been shown to be well-tolerated with minimal side effects 2
Pediatric Loading Dose Recommendations
- For status epilepticus in children, a loading dose of 20-30 mg/kg IV (maximum 1000 mg per dose) is recommended 1
- For neonates with status epilepticus, a loading dose of 10 mg/kg IV is recommended 1
- The recommended infusion time is 10-20 minutes in pediatric patients 1
Clinical Considerations
- Levetiracetam is considered a second-line agent after benzodiazepines for status epilepticus 1
- 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
- Recent research suggests that higher loading doses (≥40 mg/kg) may be associated with higher rates of intubation compared to lower doses (≤20 mg/kg or 21-39 mg/kg), without significant differences in seizure termination rates 3
Maintenance Dosing After Loading
- Maintenance dosing should begin 12 hours after the loading dose 2
- For adults, typical maintenance dosing is 500-1000 mg twice daily 4
- For children 4 to <16 years, maintenance dosing is typically 20-60 mg/kg/day divided twice daily 4
- Higher maintenance doses (750-1000 mg twice daily) have been shown to achieve target serum levels more effectively than lower doses (500 mg twice daily) in critically ill patients 5
Administration Routes
- Levetiracetam can be administered both intravenously and orally 1, 4
- Oral loading has been shown to be effective and well-tolerated in appropriate clinical scenarios 2
- Levetiracetam is given orally with or without food 4
Dosing Pitfalls to Avoid
- Underdosing is common in clinical practice, with studies showing only 54% of patients achieving target serum levels with standard dosing 5
- Critically ill patients may eliminate levetiracetam more rapidly, potentially requiring higher maintenance doses 5
- When using oral formulations for loading, ensure appropriate measurement devices are used, as household teaspoons or tablespoons are not adequate measuring devices 4