From the Guidelines
The recommended dose of Levetiracetam (Keppra) for a pediatric patient is 60 mg/kg as a rapid IV loading dose, which is safe and well tolerated, as indicated in the study published in the Annals of Emergency Medicine 1. When considering the dosing for pediatric patients, it's essential to take into account the child's age, weight, and renal function.
- The study provides a specific loading dose, but it does not provide information on the maintenance dose or dosing schedule for pediatric patients.
- However, based on the available evidence, the loading dose of 60 mg/kg IV can be used as a reference point for initiating treatment in pediatric patients.
- It's crucial to monitor the patient's response to the medication and adjust the dose as needed to achieve optimal seizure control while minimizing adverse effects.
- The medication should be administered consistently, and dosage adjustments may be necessary for children with renal impairment.
- Common side effects, such as fatigue, dizziness, and pain at the infusion site, should be closely monitored, as reported in the study 1.
- The use of Levetiracetam in pediatric patients requires careful consideration of the potential benefits and risks, and the dose should be individualized based on the patient's specific needs and response to treatment.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Pediatric Patients Ages 4 To <16 Years Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID). The daily dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID).
The recommended dose of Levetiracetam (Keppra) for a pediatric patient is:
- 20 mg/kg/day initially, divided into 2 doses
- Increased every 2 weeks by 20 mg/kg to a maximum recommended daily dose of 60 mg/kg/day (2)
From the Research
Recommended Dose of Levetiracetam for Pediatric Patients
The recommended dose of Levetiracetam for pediatric patients varies depending on the specific condition being treated and the patient's age and weight.
- For pediatric patients with migraine, the initial dose of levetiracetam was usually 125 or 250 mg twice daily, but varied depending upon clinical judgment 3.
- For pediatric patients with status epilepticus, levetiracetam was given at 20 mg/kg/dose over 5 minutes followed by a maintenance dose of 20mg/kg/dose BID 4.
- The maximum recommended dose of levetiracetam is 60 mg/kg per day, but some studies suggest that higher doses may be safe in certain cases 5.
- For children with epilepsy, doses of 130 to 140% of those advised for adults are recommended 6.
Factors Affecting Dosing
Several factors can affect the dosing of levetiracetam in pediatric patients, including:
- Age and weight: Doses are often calculated based on the patient's weight, with higher doses required for larger or older children.
- Type and severity of condition: Different conditions, such as migraine or epilepsy, may require different doses or dosing regimens.
- Individual tolerance and response: Some patients may require higher or lower doses due to individual differences in metabolism or response to the medication.
- Potential for drug interactions: Levetiracetam may interact with other medications, which can affect its efficacy or increase the risk of side effects.
Monitoring and Adjustment
While routine clinical pharmacokinetic monitoring (CPM) of levetiracetam is not generally recommended for pediatric patients with epilepsy 7, it may be beneficial in select cases, such as:
- Patients in whom noncompliance is suspected
- Those who have severe overdoses
- Those switching between product brands
- Patients for whom an 'individual therapeutic concentration' is documented.