Levetiracetam (Keppra) Dosage for Seizure Treatment
The typical dosage of levetiracetam (Keppra) for seizure treatment in adults is 1000-3000 mg/day, given as twice-daily dosing, starting with 1000 mg/day (500 mg BID) and increasing by 1000 mg/day every 2 weeks as needed. 1
Adult Dosing (16 years and older)
- Initial dose: 1000 mg/day divided as 500 mg twice daily 1
- Titration: Increase by 1000 mg/day every 2 weeks as needed 1
- Maintenance dose: 1000-3000 mg/day (typically 3000 mg/day for optimal efficacy) 1, 2
- Maximum recommended dose: 3000 mg/day, although higher doses have been used in open-label studies 1
Pediatric Dosing
- Children 4 to <16 years: Start with 20 mg/kg/day divided into two doses (10 mg/kg twice daily) 1
- Titration: Increase by 20 mg/kg every 2 weeks 1
- Target dose: 60 mg/kg/day (30 mg/kg twice daily) 1
- For children ≤20 kg: Use oral solution 1
- For children >20 kg: Can use either tablets or oral solution 1
Dosing for Specific Seizure Types
Partial Onset Seizures
- Adults: 1000-3000 mg/day (500-1500 mg twice daily) 1
- Children: 20-60 mg/kg/day (10-30 mg/kg twice daily) 1
Myoclonic Seizures (12 years and older)
- Start with 1000 mg/day (500 mg twice daily) 1
- Increase by 1000 mg/day every 2 weeks 1
- Recommended dose: 3000 mg/day 1
Primary Generalized Tonic-Clonic Seizures
- Adults: Same as partial onset seizures 1
- Children 6 to <16 years: 20-60 mg/kg/day (10-30 mg/kg twice daily) 1
Status Epilepticus Dosing
- For benzodiazepine-resistant status epilepticus: 30 mg/kg IV at a rate of 5 mg/kg per minute 3, 4
- In clinical studies, levetiracetam showed a 73% response rate in patients with status epilepticus at this dose 3
Administration Considerations
- Levetiracetam can be taken with or without food 1
- For patients unable to swallow tablets, oral solution is available 1
- For IV administration in acute settings, administer at 5 mg/kg per minute 3
Efficacy Considerations
- At 2000 mg/day, approximately 37% of adults achieve a ≥50% reduction in seizure frequency compared to 8% with placebo 2
- Clinical trials have shown that levetiracetam is effective as adjunctive therapy for partial onset seizures at doses of 1000,2000, and 3000 mg/day 5
- The Number Needed to Treat for an additional beneficial outcome is approximately 5 for adults and 4 for children 2
Monitoring and Adverse Effects
- Most common adverse effects include somnolence, asthenia, headache, and dizziness 5
- In adults, somnolence (RR 1.51) and infection (RR 1.76) are significantly associated with levetiracetam 2
- In children, behavioral changes may occur in up to 23% of patients 2
- No clinically relevant interactions with other anticonvulsants, digoxin, warfarin, or oral contraceptives 5
Levetiracetam's favorable tolerability profile and low potential for drug interactions make it a valuable option for seizure treatment, though dosage should be adjusted based on clinical response and tolerability.