From the Guidelines
The recommended dose of IV Keppra for acute seizure is up to 60 mg/kg, which can be administered rapidly and is safe and well tolerated. This dose is based on the study by 1, which found that rapid IV loading of levetiracetam (Keppra) is safe and effective in doses up to 60 mg/kg. The study also notes that oral loading of 1,500 mg is an alternative option. Some key points to consider when administering IV Keppra include:
- The medication can be administered rapidly, making it a convenient option for emergency situations
- The dose is weight-based, with a maximum dose of 60 mg/kg
- IV Keppra is generally well tolerated, with common side effects including fatigue, dizziness, and rarely, pain at the infusion site
- The medication has a favorable safety profile, with minimal drug interactions and no requirement for serum level monitoring
- Patients should be monitored for potential adverse effects, including behavioral changes, coordination difficulties, and rarely, serious skin reactions. It's also important to note that the choice of administration route (oral versus parenteral) is at the discretion of the emergency physician, as there is a lack of evidence to support one route over the other in terms of preventing early recurrent seizure, as noted in the study by 1.
From the FDA Drug Label
2 DOSAGE & ADMINISTRATION
- 1 General Information – Administration Levetiracetam in Sodium Chloride Injection is for intravenous infusion only. It is available in the following concentrations: three single-dose 100 mL bags, each containing a different total dosage of levetiracetam (500 mg [5 mg/mL], 1000 mg [10 mg/mL], or 1500 mg [15 mg/mL]) A single-dose bag should be administered intravenously over a 15-minute IV infusion period.
The dose of IV Keppra for acute seizure is 500 mg, 1000 mg, or 1500 mg administered intravenously over a 15-minute IV infusion period 2.
- The available concentrations are:
- 500 mg [5 mg/mL]
- 1000 mg [10 mg/mL]
- 1500 mg [15 mg/mL] However, the initial dose for acute seizure is not explicitly stated in the label. The initial exposure to levetiracetam can be initiated with either intravenous or oral administration, with a daily dose of 1000 mg/day given as twice-daily dosing (500 mg twice daily) for partial-onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures. When switching from oral levetiracetam, the initial total daily intravenous dosage of levetiracetam should be equivalent to the total daily dosage and frequency of oral levetiracetam.
From the Research
Dose of IV Keppra for Acute Seizure
- The dose of IV Keppra (levetiracetam) for acute seizure is not explicitly stated in the provided studies as a standard or recommended dose.
- However, in the study 3, IV levetiracetam was administered at a dose of 20mg/kg, which was compared to IV phenytoin (20mg/kg) in the management of status epilepticus.
- Another study 4 also mentions the use of IV levetiracetam, but does not specify the dose used in the study.
- A study on the clinical pharmacology and pharmacokinetics of levetiracetam 5 mentions that IV levetiracetam is approved by the FDA as an adjunctive treatment in patients 16 years or older when oral administration is not available, but does not provide a specific dose for acute seizure management.
- It is worth noting that the dose of IV Keppra may vary depending on the specific clinical scenario and patient population, and should be determined by a healthcare professional based on individual patient needs and medical history.