From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) 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 starting dose of Keppra (levetiracetam) is:
- 1000 mg/day (given as twice-daily dosing of 500 mg BID) for adults 16 years and older
- 20 mg/kg/day (given as twice-daily dosing of 10 mg/kg BID) for pediatric patients ages 4 to <16 years 1
From the Research
The typical starting dose of Keppra (levetiracetam) for adults with epilepsy is 500 mg taken twice daily, for a total daily dose of 1,000 mg, as supported by the most recent and highest quality study 2.
Key Considerations
- The dose is usually initiated and maintained for the first two weeks before considering any increases.
- For children, the starting dose is weight-based, typically 10 mg/kg twice daily.
- Keppra should be taken consistently at the same times each day to maintain stable blood levels.
- The medication can be taken with or without food, and the extended-release formulation (Keppra XR) is taken once daily.
Dose Titration
- Dosage may be gradually increased by your doctor based on seizure control and tolerability, typically by 1,000 mg per day every two weeks up to a maximum of 3,000 mg daily for most adults.
- Starting at a lower dose and gradually increasing helps minimize side effects like dizziness, drowsiness, and irritability.
Special Populations
- Patients with kidney impairment require lower starting doses and slower titration.
- Never stop taking Keppra abruptly as this can trigger seizures; any discontinuation should be done gradually under medical supervision.
Evidence Summary
The most recent study 2 from 2022, a systematic review and meta-analysis, provides the highest quality evidence for the starting dose of Keppra, although it focuses on seizure prophylaxis in neurocritical care. Other studies, such as 3, 4, 5, and 6, provide additional information on the efficacy and tolerability of levetiracetam but are older or have different focuses. However, they generally support the starting dose and titration strategy outlined above.