From the FDA Drug Label
Table 16: Dosing Adjustment Regimen For Adult Patients With Impaired Renal Function Group Creatinine Clearance (mL/min) Dosage (mg) Frequency
- Following dialysis, a 250 to 500 mg supplemental dose is recommended Normal >80 500 to 1,500 Every 12 h Mild 50 to 80 500 to 1,000 Every 12 h Moderate 30 to 50 250 to 750 Every 12 h Severe <30 250 to 500 Every 12 h ESRD patients using dialysis ---- 500 to 1,000* Every 24 h
For a patient with a creatinine clearance of 50 mL/min, the recommended dosage of levetiracetam is 500 to 1,000 mg every 12 hours, according to the dosing adjustment regimen for adult patients with impaired renal function 1.
From the Research
For a patient with a creatinine clearance of 50 mL/min, the recommended Keppra (levetiracetam) dosage is 500-1000 mg twice daily, with no significant dose adjustment required at this level of renal function, as supported by the most recent and highest quality study 2.
Key Considerations
- The standard adult dosing range for Keppra is 1000-3000 mg daily, divided into two equal doses.
- When initiating therapy, it's common to start at 500 mg twice daily and titrate upward based on clinical response and tolerability.
- Levetiracetam is primarily eliminated unchanged through the kidneys, which explains why dosage adjustments become necessary with more severe renal impairment.
- Patients should take Keppra consistently with respect to meals, though food does not significantly affect absorption.
- Common side effects include somnolence, dizziness, and behavioral changes, which should be monitored.
- Regular kidney function assessment is recommended during long-term therapy, especially if there are concerns about declining renal function.
Renal Impairment Considerations
- According to the study 2, significant dose reductions are only necessary when creatinine clearance falls below 50 mL/min.
- However, another study 3 suggests that a twice daily dosing of 750-1000 mg with an initial loading dose of 60 mg/kg should be considered in patients with renal impairment, alongside therapeutic drug monitoring.
Clinical Implications
- The study 2 highlights the importance of considering augmented renal clearance (ARC) in critically ill patients, which can lead to sub-therapeutic drug levels and treatment failure.
- The study 3 provides a novel pharmacokinetic model to optimize dosing in critically ill patients, which can help guide clinical decision-making.
- Overall, the recommended dosage of 500-1000 mg twice daily for a patient with a creatinine clearance of 50 mL/min is supported by the most recent and highest quality evidence, with consideration for individual patient factors and close monitoring of kidney function and clinical response.