Recommended Loading Dose for Keppra (Levetiracetam)
For status epilepticus in adults, the recommended loading dose of levetiracetam is 30-60 mg/kg IV (maximum 4500 mg), administered at a rate of 100 mg/min. 1
Adult Loading Dose Recommendations
- For adults with status epilepticus, a loading dose of 30-50 mg/kg IV at a rate of 100 mg/min is recommended by the American College of Emergency Physicians 1
- In clinical practice, typical fixed dosing in adults is 1500-3000 mg IV 1
- The administration rate should not exceed 100 mg/min to minimize adverse effects 1
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 has been shown to be effective 1
- For neonates with status epilepticus, a lower loading dose of 10 mg/kg IV is recommended 1
- The recommended infusion time for pediatric patients is 10-20 minutes 1
Administration Considerations
- Levetiracetam is administered as an intravenous infusion only, without dilution prior to use 2
- Unlike phenytoin/fosphenytoin, levetiracetam does not require cardiac monitoring during administration 1
- Levetiracetam has minimal drug interactions, making it suitable for patients on multiple medications 1
Clinical Pearls
- Levetiracetam is considered a second-line agent after benzodiazepines for status epilepticus 1
- A recent study comparing intravenous push (IVP) versus IV piggyback (IVPB) administration found that IVP reduced time to levetiracetam administration without increasing adverse events 3
- Higher loading doses (≥40 mg/kg) have been associated with increased rates of intubation compared to lower doses (≤20 mg/kg or 21-39 mg/kg) 4
- In patients with renal impairment, dose adjustment is necessary based on creatinine clearance 2
- For patients receiving continuous venovenous hemofiltration (CVVH), a loading dose of 2000 mg followed by maintenance doses of 1000 mg every 12 hours has been reported to be effective 5
Efficacy and Safety Considerations
- The effectiveness of levetiracetam for status epilepticus varies, with studies showing efficacy rates between 38-89% 1
- A study comparing different loading doses (≤20 mg/kg, 21-39 mg/kg, or ≥40 mg/kg) found no significant difference in seizure termination rates at 60 minutes or recurrent seizure activity at 24 hours 4
- Oral loading with 1500 mg has been shown to be well-tolerated in studies, with minimal side effects reported (11% of patients reporting transient irritability, imbalance, tiredness, or lightheadedness) 6
- Common adverse effects with levetiracetam include somnolence, asthenia, infection, and dizziness 2