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
- Administration rate should not exceed 100 mg/min to minimize adverse effects 1
- IV push (IVP) administration has been shown to reduce time to administration compared to IV piggyback (IVPB) without increasing adverse events (12 vs. 38 minutes, p<0.001) 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 non-convulsive status epilepticus in children, a loading dose of 40 mg/kg (maximum 2,500 mg) IV bolus is recommended 3
- For convulsive status epilepticus in children, a loading dose of 40 mg/kg (maximum 2,500 mg) IV bolus is recommended 3
- 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
Oral Loading Dose
- Oral loading with 1,500 mg as a single dose has been shown to be well-tolerated in adults, with maintenance dosing beginning 12 hours later at 500-1,000 mg twice daily 4
- Oral loading rapidly yields therapeutic serum concentrations and may facilitate earlier discharge from monitoring units 4
Maintenance Dosing After Loading
- After resolution of status epilepticus in children, maintenance doses of levetiracetam 15 mg/kg (maximum 1,500 mg) IV every 12 hours for non-convulsive status 3
- For convulsive status epilepticus in children, maintenance doses of 30 mg/kg IV every 12 hours or increase the prophylaxis dose by 10 mg/kg (to 20 mg/kg) IV every 12 hours (maximum dose of 1,500 mg) 3
- Higher maintenance doses (750-1,000 mg twice daily) in critically ill adult patients are more likely to achieve target serum levels (12-46 μg/mL) compared to lower doses (500 mg twice daily) 5
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
- Critically ill patients eliminate levetiracetam more rapidly than healthy individuals, potentially requiring higher maintenance doses 5
- Common adverse effects include somnolence and asthenia, which may increase with higher doses 6