What is the recommended preparation and administration protocol for an intravenous (IV) Keppra (levetiracetam) 500mg infusion?

IV Levetiracetam 500mg Infusion Preparation and Administration

Administer levetiracetam 500mg IV undiluted over 15 minutes using the pre-mixed single-dose bag without any further preparation required. 1

Preparation Protocol

No Dilution Required

• Do not dilute the medication prior to use - levetiracetam comes as a ready-to-use formulation in single-dose bags 1
• The 500mg dose is supplied as 500mg/100mL in 0.82% sodium chloride (5mg/mL concentration) 1
• Use the dose-specific bag directly from the package 1

Equipment Setup

• Verify the correct dose-specific bag (500mg/100mL) 1
• Standard IV tubing is appropriate for administration 1
• Either peripheral or central venous access can be used safely 2

Administration Protocol

Standard Infusion Rate

• Infuse the entire 500mg dose intravenously over 15 minutes 1
• This is the FDA-approved administration rate for all levetiracetam IV doses 1

Alternative Rapid Infusion (Off-Label)

• Rapid infusion over 5 minutes has been demonstrated safe in multiple studies, though this remains off-label 2, 3
• Doses up to 2,500mg infused over 5 minutes showed similar safety profiles to the standard 15-minute infusion 3
• Undiluted levetiracetam can be safely administered via peripheral line even at rapid infusion rates 2

Dosing Context

Initial Dosing for Seizures

• 500mg twice daily is the standard initial dose for partial-onset seizures, myoclonic seizures in juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures 1
• Doses can be increased by 500mg twice daily every 2 weeks up to a maximum of 1,500mg twice daily 1

Conversion from Oral

• The total daily IV dosage and frequency should be equivalent to the oral levetiracetam regimen 1
• IV formulation is indicated when oral administration is temporarily not feasible 1

Safety Monitoring

Expected Adverse Effects

• Most common adverse effects include somnolence, asthenia, dizziness, and fatigue - these are primarily CNS-related 1, 4, 3
• Adverse effects typically appear early after initiation and generally resolve without medication withdrawal 4
• No clear relationship exists between adverse event incidence and infusion rate (5 vs 15 minutes) 3

Serious Warnings

• Monitor for behavioral abnormalities including psychotic symptoms, suicidal ideation, irritability, and aggressive behavior - these are more common in children and patients with prior behavioral problems 1, 4
• Discontinue at first sign of rash unless clearly not drug-related due to risk of serious dermatological reactions 1
• Watch for Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/multiorgan hypersensitivity 1
• Monitor for coordination difficulties including ataxia and abnormal gait 1

Renal Adjustment

• Dose adjustment is necessary based on creatinine clearance in patients with renal impairment 1

Critical Pitfalls to Avoid

• Do not attempt to further dilute the pre-mixed formulation - this is unnecessary and may lead to medication errors 1
• Do not abruptly discontinue - levetiracetam must be gradually withdrawn to prevent withdrawal seizures 1
• Do not confuse the different concentration bags (500mg, 1000mg, 1500mg formulations have different sodium chloride percentages) 1

Pharmacokinetic Considerations

• Steady state is reached within 48 hours with twice-daily dosing 5
• IV and oral formulations are bioequivalent with similar AUC and Cmax values 5
• Terminal half-life is approximately 7-8 hours 3