IV Loading Dose of Keppra (Levetiracetam)
For adults with status epilepticus, administer 30-60 mg/kg IV (maximum 4500 mg) at a rate of 100 mg/min, with typical fixed dosing of 1500-3000 mg IV. 1
Adult Dosing
- The standard loading dose is 30-60 mg/kg IV with a maximum of 4500 mg, infused at 100 mg/min 1
- For practical purposes in adults, fixed dosing of 1500-3000 mg IV is commonly used rather than weight-based calculations 1
- The most recent high-quality evidence supports 30-50 mg/kg IV at 100 mg/min for benzodiazepine-refractory status epilepticus 1
Important Administration Details
- Do not exceed an infusion rate of 100 mg/min to minimize adverse effects 1
- No cardiac monitoring is required during administration, unlike phenytoin/fosphenytoin 1
- Levetiracetam is a second-line agent after benzodiazepines for status epilepticus 1
Pediatric Dosing
- For children with status epilepticus: 20-30 mg/kg IV (maximum 1000 mg per dose) 1
- For neonates: 10 mg/kg IV 1
- Recent evidence supports 40 mg/kg IV (maximum 2500 mg) for both convulsive and non-convulsive status epilepticus in children 1
- Infuse over 10-20 minutes in pediatric patients 1
Clinical Considerations
Efficacy Data
- A 2024 study found no significant difference in seizure termination rates between low (≤20 mg/kg), medium (21-39 mg/kg), and high (≥40 mg/kg) loading doses at 60 minutes (92.9% vs 89.3% vs 84.7%, p=0.377) 2
- However, doses >40 mg/kg were associated with higher intubation rates (45.8% vs 28.2% vs 26.8%, p=0.040) 2
Practical Advantages
- Minimal drug interactions make it suitable for patients on multiple medications 1
- Oral loading with 1500 mg is well-tolerated in adults, achieving therapeutic levels (30-31 μg/mL) within 1-2 hours 3
- For critically ill patients requiring seizure prophylaxis (not status epilepticus), higher maintenance doses (750-1000 mg bid) achieve target levels more reliably than 500 mg bid 4
Common Pitfall
The most common error is underdosing—only 54% of critically ill patients on prophylactic dosing achieve therapeutic levels with standard regimens 4. For acute status epilepticus, use the full recommended loading dose rather than conservative dosing.