Levetiracetam Infusion Speed
The recommended infusion speed for intravenous levetiracetam is 5 mg/kg per minute, which translates to a 15-minute infusion for standard dosing. 1, 2
Standard FDA-Approved Administration
- The FDA-approved formulation specifies that levetiracetam should be administered as a 15-minute infusion when given intravenously 2
- This infusion rate was validated in bioequivalence studies showing that a 1500 mg dose diluted in 100 mL of 0.9% sterile saline and infused over 15 minutes produces plasma concentrations equivalent to oral administration 2, 3
- The 15-minute infusion provides plasma concentrations at the end of infusion similar to those achieved at Tmax after an equivalent oral dose 2
Dosing for Status Epilepticus
When using levetiracetam for status epilepticus or refractory seizures, the infusion parameters are more specifically defined:
- Dose: 30 mg/kg IV for benzodiazepine-resistant status epilepticus 1
- Rate: 5 mg/kg per minute 4, 1
- For a 70 kg patient receiving 2100 mg (30 mg/kg), this translates to 350 mg/minute, completing the infusion in approximately 6 minutes
- Lower doses of 20 mg/kg have shown reduced efficacy (38% response rate) compared to 30 mg/kg dosing 4
Rapid Infusion Evidence
Recent evidence supports faster administration rates than the FDA-approved 15-minute infusion:
- Rapid infusion over 5 minutes appears safe and well-tolerated based on systematic review of multiple studies 5
- Doses ranging from 280 to 4500 mg have been administered over 5 minutes without significant adverse effects related to infusion speed or concentration 5
- Rapid infusion can be given via peripheral IV access 5
- Few adverse effects specifically related to medication concentration or infusion speed were reported across multiple trials 5
Clinical Context and Practical Considerations
For emergency situations (status epilepticus):
- Use 30 mg/kg at 5 mg/kg per minute, which results in approximately a 6-minute infusion for average-sized adults 4, 1
- This faster rate is supported by guideline evidence showing 73% efficacy in benzodiazepine-resistant status epilepticus 4, 1
For non-emergent situations:
- The standard 15-minute infusion remains appropriate and is the FDA-approved method 2
- This rate has been extensively validated for safety and bioequivalence 3
Important Caveats
- Monitor clinical response and EEG after administration when treating seizures 1
- The rapid infusion data (5 minutes) comes primarily from retrospective studies and small trials, though a systematic review supports its safety 5
- No dose adjustments for infusion rate are needed based on age, though elderly patients may have prolonged elimination due to reduced renal clearance 2, 6