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, as indicated by the most recent and highest quality study 2. This dosage represents a moderate adjustment from the standard dosing used in patients with normal renal function. Levetiracetam is primarily eliminated unchanged through the kidneys, so dose adjustment is necessary when renal function is impaired. With a creatinine clearance of 50 mL/min, which indicates moderate renal impairment, the drug's clearance is reduced, potentially leading to drug accumulation if standard doses are used. Key points to consider include:
- Patients should take Keppra at regular intervals approximately 12 hours apart to maintain therapeutic blood levels.
- The medication can be taken with or without food.
- Dose titration should be done gradually, starting at the lower end of the range and increasing based on seizure control and tolerability.
- Common side effects include somnolence, dizziness, and behavioral changes.
- Regular monitoring of renal function is recommended, as further decline may necessitate additional dose adjustments, as suggested by 3 and 4. It's also important to note that while 5 discusses the use of levetiracetam in neurocritical care, its findings do not directly impact the dosing recommendation for a patient with a creatinine clearance of 50 mL/min. Therefore, the primary consideration for dosing in this context remains the patient's renal function, as emphasized by 2.