From the Guidelines
A Keppra level of 5.0 mcg/mL is within the therapeutic range, which is typically considered to be between 5.0 and 40.0 mcg/mL, as indicated by studies such as 1. This level indicates that the medication concentration in the blood is adequate for seizure control for most patients. No dosage adjustment is needed if the patient is seizure-free and not experiencing side effects. However, therapeutic drug monitoring for Keppra is not routinely required since it has a wide therapeutic window and good correlation between dose and serum levels, as seen in the information provided in 1. The effectiveness of Keppra is more commonly assessed by clinical response (seizure control) rather than blood levels. Some key points to consider when evaluating Keppra levels include:
- The therapeutic range for Keppra is between 5.0 and 40.0 mcg/mL
- Side effects to watch for include fatigue, dizziness, and mood changes, which can occur even at therapeutic levels
- If the patient is experiencing breakthrough seizures despite this level, the neurologist might consider increasing the dose, as some individuals require higher concentrations for optimal seizure control
- Keppra is eliminated primarily by the kidneys, so dosage adjustments may be necessary in patients with renal impairment, as noted in 1. In terms of administration, a loading dose of 1,500 mg oral load or rapid IV loading safe and well tolerated in doses up to 60 mg/kg can be considered, as indicated by 1. It's essential to monitor the patient's response to the medication and adjust the dose as needed to minimize side effects and optimize seizure control, taking into account the information provided in 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Keppra Levels
- The therapeutic range for Keppra (levetiracetam) is 20-40mg/L 2
- A study found that 70% of patients on Keppra monotherapy had therapeutic levels, and 81% of those patients were seizure-free 2
- Another study found that age and comedication can affect the pharmacokinetic variability of Keppra, with age having the greatest impact on Keppra clearance 3
Keppra Efficacy
- Keppra has been shown to be effective in controlling seizures in patients with epilepsy, with a significant reduction in seizure frequency compared to placebo 4
- A network meta-analysis found that Keppra performed significantly better than carbamazepine and lamotrigine in terms of time to withdrawal of allocated treatment for individuals with partial seizures 5
- Keppra has also been found to be effective as adjunctive therapy in patients with idiopathic generalized epilepsy with myoclonic seizures or generalized tonic-clonic seizures 4
Keppra Interactions
- Keppra does not have significant pharmacokinetic interactions with other drugs, including other antiepileptic drugs 4
- However, comedication with other antiepileptic drugs can affect Keppra levels, with some drugs increasing or decreasing Keppra clearance 2, 3
- Valproic acid has been found to reduce the clearance of Keppra, while hepatic enzyme inducers can increase the clearance of Keppra 3