Levetiracetam (Syp Levera) Dosing for a 4-Year-Old Child
For a 4-year-old child with epilepsy, start levetiracetam at 10 mg/kg twice daily (20 mg/kg/day total), increasing every 2 weeks by 10 mg/kg twice daily increments to a target dose of 30 mg/kg twice daily (60 mg/kg/day total). 1
Weight-Based Dosing Calculation
To determine the exact milliliter dose, you must first know the child's weight:
Formula: Total daily dose (mL/day) = [Daily dose (mg/kg/day) × patient weight (kg)] ÷ 100 mg/mL 1
Starting Dose (20 mg/kg/day)
- Example for 15 kg child: (20 mg/kg/day × 15 kg) ÷ 100 = 3 mL/day → Give 1.5 mL twice daily 1
- Example for 20 kg child: (20 mg/kg/day × 20 kg) ÷ 100 = 4 mL/day → Give 2 mL twice daily 1
Target Maintenance Dose (60 mg/kg/day)
- Example for 15 kg child: (60 mg/kg/day × 15 kg) ÷ 100 = 9 mL/day → Give 4.5 mL twice daily 1
- Example for 20 kg child: (60 mg/kg/day × 20 kg) ÷ 100 = 12 mL/day → Give 6 mL twice daily 1
Titration Schedule
Week 1-2: Start at 10 mg/kg twice daily (20 mg/kg/day total) 1
Week 3-4: Increase to 20 mg/kg twice daily (40 mg/kg/day total) 1
Week 5+: Increase to target 30 mg/kg twice daily (60 mg/kg/day total) 1
If the child cannot tolerate 60 mg/kg/day, the dose may be reduced, though clinical trial data showed a mean effective dose of 52 mg/kg/day in pediatric patients 1
Critical Administration Details
- Use oral solution for children ≤20 kg body weight 1
- Use a calibrated measuring device, NOT household teaspoons or tablespoons 1
- Administer with or without food 1
- Divide total daily dose into two equal doses given 12 hours apart 1
Clinical Context
Levetiracetam is FDA-approved for children ≥4 years old as adjunctive therapy for partial onset seizures 1. Pediatric studies demonstrate 39-52% of children achieve >50% seizure reduction, with 27% achieving seizure freedom for at least 4 weeks 2. The medication is generally well-tolerated, with the most common adverse effects being hyperactivity (48.5%), somnolence (36.4%), and irritability (33.3%), though most are mild in severity 2.
Common Pitfalls to Avoid
Never use household measuring spoons—they are inaccurate and can lead to significant dosing errors 1. Always provide caregivers with a calibrated oral syringe or dosing cup marked in milliliters.
Do not skip the titration schedule—rapid dose escalation increases the risk of behavioral adverse effects, particularly aggression and irritability 2. The 2-week titration intervals allow for tolerance development and adverse effect monitoring.
Monitor for behavioral changes closely—while levetiracetam has a favorable safety profile, 27% of children may develop aggressive behavior, which is the most common reason for discontinuation 2. However, some children paradoxically show behavioral improvements 3.