What is the loading dose for Keppra (levetiracetam)?

Levetiracetam (Keppra) Loading Dose Recommendations

For status epilepticus in adults, the recommended loading dose for Keppra (levetiracetam) is 30-60 mg/kg IV (maximum 4500 mg), administered at a rate of 100 mg/min. 1

Adult Loading Dose Recommendations

• The typical fixed loading dose in adults ranges from 1500-3000 mg IV 1
• The administration rate should not exceed 100 mg/min to minimize adverse effects 1
• For benzodiazepine-refractory status epilepticus, loading doses ranging from 20-60 mg/kg are used, with higher doses not showing increased efficacy but potentially leading to higher intubation rates 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 higher loading dose of 40 mg/kg (maximum 2,500 mg) IV bolus may be used 1
• For neonates with status epilepticus, a lower 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, making it advantageous in critical care settings 1, 3
• Levetiracetam has minimal drug interactions, making it suitable for patients on multiple medications 1
• In ICU settings, levetiracetam has been shown to be effective with 93% of patients having no subsequent seizures after treatment 3

Efficacy and Safety

• A recent study comparing different loading doses (≤20 mg/kg, 21-39 mg/kg, and ≥40 mg/kg) found no significant difference in seizure termination rates at 60 minutes (92.9%, 89.3%, and 84.7% respectively) 2
• However, higher loading doses (≥40 mg/kg) were associated with increased rates of intubation (45.8% vs 28.2% and 26.8% for medium and low doses) 2
• Oral loading with 1500 mg has been shown to be well-tolerated with minimal side effects (11% reported mild transient symptoms) 4

Maintenance Dosing After Loading

• For adults with partial onset seizures, maintenance dosing typically starts at 1000 mg/day (500 mg BID), which can be increased by 1000 mg/day every 2 weeks to a maximum of 3000 mg/day 5
• After resolution of status epilepticus in children, maintenance doses of 15-30 mg/kg IV every 12 hours are recommended 1

Common Pitfalls and Caveats

• Dosing should be adjusted for patients with renal impairment as levetiracetam is primarily eliminated by the kidneys 3
• While higher loading doses (≥40 mg/kg) don't appear to improve efficacy, they may increase the risk of respiratory depression requiring intubation 2
• When using oral loading in emergency situations, be aware that peak serum concentrations occur within 1-2 hours 4
• The effectiveness of levetiracetam for status epilepticus varies, with studies showing efficacy rates between 38-89% 6