Recommended Dosage and Treatment Protocol for Keppra (Levetiracetam) in Managing Seizures
For managing seizures in adults, Keppra (levetiracetam) should be initiated at 1000 mg/day (500 mg twice daily) with titration up to 3000 mg/day (1500 mg twice daily) based on clinical response. 1
Adult Dosing Protocols
Partial Onset Seizures (Adults ≥16 years)
- Initial dose: 1000 mg/day given as 500 mg twice daily 1
- Titration: Increase by 1000 mg/day every 2 weeks 1
- Maximum recommended dose: 3000 mg/day 1
- Administration: Can be taken with or without food 1
Myoclonic Seizures (Adults ≥12 years with Juvenile Myoclonic Epilepsy)
- Initial dose: 1000 mg/day given as 500 mg twice daily 1
- Titration: Increase by 1000 mg/day every 2 weeks 1
- Target dose: 3000 mg/day (doses lower than 3000 mg/day have not been adequately studied) 1
Primary Generalized Tonic-Clonic Seizures (Adults ≥16 years)
- Initial dose: 1000 mg/day given as 500 mg twice daily 1
- Titration: Increase by 1000 mg/day every 2 weeks 1
- Target dose: 3000 mg/day 1
Pediatric Dosing Protocols
Partial Onset Seizures (Ages 4 to <16 years)
- Initial dose: 20 mg/kg/day divided into twice daily dosing (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
- Mean effective dose in clinical trials: 52 mg/kg/day 1
Primary Generalized Tonic-Clonic Seizures (Ages 6 to <16 years)
- Initial dose: 20 mg/kg/day divided into twice daily dosing (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
Status Epilepticus Treatment
For status epilepticus refractory to benzodiazepines, evidence supports the following approach:
- IV loading dose: 20-30 mg/kg 2
- Infusion rate: 5 mg/kg/min 2
- Efficacy: Studies show 67-73% efficacy in terminating seizures 2
- Alternative dosing: 2,500 mg IV over 5 minutes has shown 83% efficacy in terminating seizures within 24 hours 2
Special Situations
Seizure Prophylaxis in Neurocritical Care
- For patients with subarachnoid hemorrhage or traumatic brain injury, dosing >1000 mg/day (typically 2000 mg/day as 1000 mg twice daily) may provide better seizure prophylaxis than the standard 1000 mg/day dosing 3
Oral Loading for Rapid Initiation
- A single 1,500 mg oral loading dose is well-tolerated and can rapidly achieve therapeutic levels 4
- Maintenance dosing can begin 12 hours later at 500-1000 mg twice daily 4
- This approach is useful for rapid initiation in settings like epilepsy monitoring units 4
CAR T-Cell Therapy Seizure Prophylaxis
- For patients receiving CAR T-cell therapy with CNS disease or history of seizures: 10 mg/kg (up to maximum 500 mg per dose) every 12 hours for 30 days following infusion 2
Efficacy and Tolerability
- Levetiracetam is effective as an adjunctive treatment for partial-onset epilepsy with or without secondary generalization 5
- In newly diagnosed epilepsy, levetiracetam shows equivalent seizure freedom rates to controlled-release carbamazepine (73.0% vs. 72.8% at 6 months) 6
- Most patients respond at lower doses, with 80.1% of responders achieving seizure freedom at the lowest dose level 6
- Common adverse effects include somnolence, dizziness, infection, and asthenia 5
- Withdrawal rates due to adverse events are approximately 14.4%, which is lower than some other antiepileptic medications 6
Important Considerations
- Levetiracetam has minimal protein binding (10%) and minimal hepatic metabolism, reducing drug interaction potential 5
- Dose adjustments may be necessary in patients with renal dysfunction 2
- For patients unable to take tablets, an oral solution is available 1
- Steady state is achieved within 2 days of twice-daily administration 5
- Abrupt discontinuation should be avoided to prevent withdrawal seizures 2