What is the recommended dosage of Keppra (levetiracetam)?

Levetiracetam (Keppra) Dosing Recommendations

For acute seizure management in adults and children ≥4 years, administer levetiracetam 40 mg/kg IV bolus (maximum 2,500 mg) as a loading dose, followed by maintenance dosing of 15-30 mg/kg IV every 12 hours (maximum 1,500 mg per dose). 1

Acute Seizure Management & Status Epilepticus

Loading Doses

• Non-convulsive status epilepticus: 40 mg/kg IV bolus (maximum 2,500 mg) in addition to benzodiazepines 2, 1
• Convulsive status epilepticus: 40 mg/kg IV bolus (maximum 2,500 mg) in addition to lorazepam 2, 1
• Adult loading doses: 1,500 mg oral load or rapid IV loading up to 60 mg/kg has been shown safe and well-tolerated, with 83% seizure termination within 24 hours 2, 1

Maintenance Dosing After Status Epilepticus

• Non-convulsive SE: 15 mg/kg IV every 12 hours (maximum 1,500 mg per dose) 2, 1
• Convulsive SE: 30 mg/kg IV every 12 hours OR increase prophylaxis dose by 10 mg/kg to 20 mg/kg IV every 12 hours (maximum 1,500 mg per dose) 2, 1
• Continue maintenance for at least 3 doses of lorazepam plus ongoing levetiracetam after seizure termination 1

Chronic Epilepsy Management (Adjunctive Therapy)

Adults (≥16 years)

• Initial dose: 1,000 mg/day given as 500 mg twice daily 3
• Titration: Increase by 1,000 mg/day every 2 weeks as needed 3
• Target dose: 3,000 mg/day (1,500 mg twice daily) 3
• Maximum dose: 3,000 mg/day (doses >3,000 mg/day show no additional benefit) 3

Pediatric Patients (4 to <16 years) - Partial Onset Seizures

• Initial dose: 20 mg/kg/day in 2 divided doses (10 mg/kg twice daily) 3
• Titration: Increase by 20 mg/kg every 2 weeks 3
• Target dose: 60 mg/kg/day (30 mg/kg twice daily) 3
• If 60 mg/kg/day not tolerated, may reduce dose (mean effective dose in trials was 52 mg/kg/day) 3

Pediatric Patients (6 to <16 years) - Primary Generalized Tonic-Clonic Seizures

• Initial dose: 20 mg/kg/day in 2 divided doses (10 mg/kg twice daily) 3
• Titration: Increase by 20 mg/kg every 2 weeks to 60 mg/kg/day 3
• Target dose: 60 mg/kg/day (30 mg/kg twice daily) 3

Adolescents (≥12 years) - Juvenile Myoclonic Epilepsy

• Initial dose: 1,000 mg/day (500 mg twice daily) 3
• Titration: Increase by 1,000 mg/day every 2 weeks 3
• Target dose: 3,000 mg/day 3

Special Situations

CAR T-Cell Therapy Seizure Prophylaxis

• Prophylactic dose: 10 mg/kg (maximum 500 mg per dose) every 12 hours for 30 days following infusion 1
• This is for prevention only, not treatment of active seizures 1

Weight-Based Dosing Considerations

• Patients ≤20 kg should use oral solution 3
• Patients >20 kg can use either tablets or oral solution 3
• Only whole tablets should be administered 3

Critical Pitfalls to Avoid

Underdosing in status epilepticus: The full 40 mg/kg loading dose (maximum 2,500 mg) must be used rather than lower prophylactic doses when treating active seizures 1. The 1,500 mg oral loading dose studied in emergency departments is insufficient for status epilepticus 2.

Premature discontinuation: After seizure termination, continue maintenance dosing as prescribed rather than stopping abruptly 1.

Renal dysfunction: Dose adjustments are necessary in patients with renal impairment, as levetiracetam is renally cleared 1.

Administration Details

• Can be given orally or intravenously 2, 3
• Oral administration can be with or without food 3
• IV infusion is safe at rates up to the maximum bolus dose 2
• Use calibrated measuring device for oral solution, not household spoons 3