What is the recommended dosage of Levipil (levetiracetam) per kg body weight?

Levetiracetam (Levipil) Dosage Per Kg Body Weight

For acute seizure management and status epilepticus, administer levetiracetam 40 mg/kg IV bolus (maximum 2,500 mg) as the loading dose, followed by maintenance dosing of 15-30 mg/kg IV every 12 hours (maximum 1,500 mg per dose). 1

Loading Dose Strategies

Acute Seizure Management and Status Epilepticus

• The American Academy of Neurology recommends 40 mg/kg IV bolus (maximum 2,500 mg) in addition to benzodiazepines for both convulsive and non-convulsive status epilepticus 1
• Alternative loading doses of 20-30 mg/kg IV have also been used effectively, though the 40 mg/kg dose represents the most current guideline recommendation 2, 1
• Pediatric data supports the safety of 20,40, and 60 mg/kg loading doses with no significant adverse effects 2
• A critical pitfall to avoid is underdosing in status epilepticus—use the full 40 mg/kg loading dose rather than lower prophylactic doses 1

Resuming Therapy in Emergency Department

• For patients with known seizure disorder resuming their antiepileptic medication, a loading dose of 1,500 mg oral or rapid IV is recommended 3, 2
• This can be administered over 5-15 minutes with excellent safety profile 2

Maintenance Dosing

Adults (16 Years and Older)

• Start with 1,000 mg/day given as twice-daily dosing (500 mg BID) 4
• Increase by 1,000 mg/day every 2 weeks to the recommended daily dose of 3,000 mg/day 4
• Maximum recommended dose is 3,000 mg/day, though doses greater than this have been used in open-label studies 4
• For status epilepticus maintenance: 15-30 mg/kg IV every 12 hours (maximum 1,500 mg per dose) 1

Pediatric Patients (4 to <16 Years)

• Start with 20 mg/kg/day in 2 divided doses (10 mg/kg BID) 4
• Increase every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID) 4
• If the patient cannot tolerate 60 mg/kg/day, the dose may be reduced 4
• In clinical trials, the mean daily dose was 52 mg/kg 4

Juvenile Myoclonic Epilepsy (≥12 Years)

• Start with 1,000 mg/day as twice-daily dosing (500 mg BID) 4
• Increase by 1,000 mg/day every 2 weeks to 3,000 mg/day 4
• Doses lower than 3,000 mg/day have not been adequately studied for this indication 4

Special Populations

Renal Impairment

• Dosing must be individualized based on creatinine clearance 4
• Mild impairment (CLcr 50-80 mL/min): 500-1,000 mg every 12 hours 4
• Moderate impairment (CLcr 30-50 mL/min): 250-750 mg every 12 hours 4
• Severe impairment (CLcr <30 mL/min): 250-500 mg every 12 hours 4
• ESRD on dialysis: 500-1,000 mg every 24 hours, with 250-500 mg supplemental dose following dialysis 4

CAR T-Cell Therapy Prophylaxis

• The National Comprehensive Cancer Network recommends 10 mg/kg (maximum 500 mg per dose) every 12 hours for 30 days following CAR T-cell therapy infusion for seizure prevention 1

Safety Profile

Adverse Effects

• Most commonly reported adverse events are CNS-related: somnolence, asthenia, headache, and dizziness 3, 5
• In oral loading studies, 89% of patients reported no adverse effects, with only 11% experiencing transient irritability, imbalance, tiredness, or lightheadedness 2, 6
• Levetiracetam has a better tolerability profile than phenytoin or valproic acid, with lower incidence of adverse effects 6
• Pediatric IV loading showed no significant blood pressure changes, no local infusion site reactions, and no ECG abnormalities 2
• Case reports document safety even with accidental overdoses up to 200 mg/kg/day for prolonged periods 7

Administration Considerations

• Can be given orally with or without food 4
• IV administration can be given rapidly (over 5 minutes) with low incidence of hypotension (1.7-3.2%) and bradycardia (3.5-7.8%) 2
• No serious adverse effects attributable to rapid infusion at 5 mg/kg per minute in status epilepticus studies 6
• Minimal drug interactions with other antiepileptic drugs, digoxin, warfarin, or oral contraceptives 8