What is the maximum recommended dosage of Levetiracetam (Keppra) per kg body weight in a 17-year-old?

Maximum Levetiracetam Dosage in a 17-Year-Old

For a 17-year-old, the maximum recommended levetiracetam dosage is 60 mg/kg/day for chronic seizure management (divided into twice-daily dosing), with an absolute maximum of 3000 mg/day, or up to 60 mg/kg as a single loading dose (maximum 4500 mg) for acute status epilepticus. 1, 2, 3

Context-Dependent Maximum Dosing

The maximum dose varies significantly based on clinical indication:

For Chronic Seizure Management (Maintenance Therapy)

• 60 mg/kg/day divided twice daily (30 mg/kg BID) is the maximum recommended maintenance dose for adolescents, with an absolute ceiling of 3000 mg/day regardless of weight 1
• The FDA label specifies that adolescents 16 years and older should follow adult dosing: start at 1000 mg/day (500 mg BID) and titrate by 1000 mg/day every 2 weeks up to a maximum of 3000 mg/day 1
• For adolescents under 16 years, pediatric weight-based dosing applies: maximum 60 mg/kg/day (30 mg/kg BID), which may exceed 3000 mg/day in heavier patients 1

For Acute Status Epilepticus (Loading Dose)

• 40-60 mg/kg IV as a single loading dose is recommended by multiple guideline organizations, with a maximum of 2500-4500 mg depending on the source 2, 3, 4
• The American Academy of Neurology and American Academy of Pediatrics recommend 40-60 mg/kg IV loading doses for status epilepticus, with a maximum of 2500 mg cited in pediatric guidelines 2, 3
• More recent evidence supports loading doses up to 60 mg/kg with a maximum of 4500 mg for refractory status epilepticus 4, 5

Age-Specific Considerations for 17-Year-Olds

A 17-year-old falls into a transitional zone between pediatric and adult dosing:

• If the patient weighs >40 kg, adult dosing guidelines apply for maintenance therapy (maximum 3000 mg/day) 1
• For status epilepticus, weight-based dosing of 40-60 mg/kg should be used regardless of the adult/pediatric classification, as this provides superior therapeutic drug concentrations 5
• The FDA label indicates adult dosing begins at 16 years of age, so a 17-year-old would technically follow adult guidelines for maintenance therapy 1

Critical Dosing Pitfalls to Avoid

• Do not underdose in status epilepticus: The American Academy of Neurology specifically warns against using lower prophylactic doses (20-30 mg/kg) when the full 40-60 mg/kg loading dose is indicated 3
• Fixed dosing may be inadequate: In patients >60 kg, fixed doses <3000 mg may not achieve therapeutic concentrations before maintenance dosing is needed; weight-based dosing of 40 mg/kg up to 4500 mg is preferred 5
• Maintenance dosing differs from loading: After a loading dose for status epilepticus, maintenance dosing is 15-30 mg/kg IV every 12 hours (maximum 1500 mg per dose), not the full loading dose repeated 3

Renal Adjustment Required

• Dose reduction is mandatory in renal dysfunction: For creatinine clearance <80 mL/min, maximum doses must be reduced according to renal function, with severe renal impairment requiring doses as low as 250-500 mg every 12 hours 1
• The National Kidney Foundation emphasizes that levetiracetam requires renal dose adjustment, which is particularly relevant in adolescents with underlying kidney disease 3

Safety Profile at Maximum Doses

• Pediatric studies demonstrate that loading doses of 20,40, and 60 mg/kg are safe with no significant adverse effects, blood pressure changes, or ECG abnormalities 4
• However, recent evidence suggests that loading doses ≥40 mg/kg may be associated with higher intubation rates (45.8% vs 26.8-28.2% with lower doses), though this may reflect seizure severity rather than drug effect 6
• Doses >3000 mg/day have been used in open-label studies for 6+ months without evidence of additional benefit, suggesting 3000 mg/day is a practical ceiling for chronic therapy 1