Recommended Dosage of Levetiracetam (Levepil)
The recommended dosage of Levetiracetam (Levepil) for adults with partial onset seizures is 1000 mg/day initially (500 mg twice daily), which can be increased by 1000 mg/day every 2 weeks to a maximum recommended daily dose of 3000 mg. 1
Adult Dosing
Partial Onset Seizures (Adults 16 Years and Older)
- Initial dose: 1000 mg/day, given as twice-daily dosing (500 mg BID) 1
- Titration: Additional dosing increments of 1000 mg/day every 2 weeks 1
- Maximum recommended daily dose: 3000 mg 1
- Administration: Can be given orally with or without food 1
Myoclonic Seizures (12 Years and Older with Juvenile Myoclonic Epilepsy)
- Initial dose: 1000 mg/day, given as twice-daily dosing (500 mg BID) 1
- Titration: Increase by 1000 mg/day every 2 weeks 1
- Recommended daily dose: 3000 mg 1
Primary Generalized Tonic-Clonic Seizures (Adults 16 Years and Older)
- Initial dose: 1000 mg/day, given as twice-daily dosing (500 mg BID) 1
- Titration: Increase by 1000 mg/day every 2 weeks 1
- Recommended daily dose: 3000 mg 1
Pediatric Dosing
Partial Onset Seizures (Ages 4 to <16 Years)
- Initial dose: 20 mg/kg/day in 2 divided doses (10 mg/kg BID) 1
- Titration: Increase by 20 mg/kg every 2 weeks 1
- Recommended daily dose: 60 mg/kg/day (30 mg/kg BID) 1
- For patients who cannot tolerate 60 mg/kg/day, the dose may be reduced 1
Primary Generalized Tonic-Clonic Seizures (Ages 6 to <16 Years)
- Initial dose: 20 mg/kg/day in 2 divided doses (10 mg/kg BID) 1
- Titration: Increase by 20 mg/kg every 2 weeks 1
- Recommended daily dose: 60 mg/kg/day (30 mg/kg BID) 1
Special Clinical Scenarios
Status Epilepticus
- For non-convulsive status epilepticus: Loading dose of 40 mg/kg (maximum 2,500 mg) IV bolus, followed by maintenance dose of 15 mg/kg (maximum 1,500 mg) IV every 12 hours 2
- For convulsive status epilepticus: Loading dose of 40 mg/kg (maximum 2,500 mg) IV bolus, followed by maintenance dose of 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
Neurocritical Care (Seizure Prophylaxis)
- Higher doses (>1000 mg total daily dose, typically 1000 mg twice daily) may be more effective for seizure prophylaxis in patients with subarachnoid hemorrhage or traumatic brain injury 3
- Standard dose of 500 mg twice daily may be associated with higher seizure incidence compared to 1000 mg twice daily in these patients 3
Busulfan-Induced Seizure Prevention
- Adults: 500-1000 mg twice daily 4
- Children: 10 mg/kg twice daily (20 mg/kg/day in 2 divided doses) 4
- Start 6-24 hours before busulfan initiation and continue until 24-48 hours after the last dose 4
Oral Loading
- In situations requiring rapid initiation, oral loading with 1500 mg as a single dose has been shown to be well-tolerated 5
- Maintenance dosing can begin 12 hours later at 500-1000 mg twice daily 5
Important Considerations
- Levetiracetam has a broad therapeutic window and predictable pharmacokinetics 6
- Routine therapeutic drug monitoring is generally not recommended 6
- No clinically relevant drug interactions have been observed with other anticonvulsants, digoxin, warfarin, or oral contraceptives 7
- Common side effects include somnolence, asthenia, headache, and dizziness 7
Levetiracetam has shown efficacy as both monotherapy and adjunctive therapy, with equivalent seizure freedom rates compared to controlled-release carbamazepine in newly diagnosed epilepsy 8.