Usual Injectable Levetiracetam (Levipil) Doses Available
Injectable levetiracetam is available in three standard concentrations: 500 mg/100 mL (5 mg/mL), 1000 mg/100 mL (10 mg/mL), and 1500 mg/100 mL (15 mg/mL), all supplied as single-dose bags in 0.9% sodium chloride solution. 1
Available Formulations
The FDA-approved levetiracetam injection comes in the following ready-to-use preparations 1:
- 500 mg/100 mL (5 mg/mL concentration) in 0.82% sodium chloride
- 1000 mg/100 mL (10 mg/mL concentration) in 0.75% sodium chloride
- 1500 mg/100 mL (15 mg/mL concentration) in 0.54% sodium chloride
All formulations are clear, colorless solutions packaged in single-dose bags that should not be further diluted prior to use. 1
Standard Dosing Regimens
For Status Epilepticus (Second-Line After Benzodiazepines)
The recommended loading dose is 30 mg/kg IV (maximum 3000 mg) administered over 5-15 minutes, followed by maintenance dosing of 500-1500 mg every 12 hours. 2
- Alternative studied dosing includes 1500-2500 mg IV over 5 minutes in elderly patients, with 89% reduction in seizures 3
- Lower doses of 20 mg/kg show significantly reduced efficacy (38-67%) and should be avoided 2
- The 30 mg/kg dose achieves 68-73% efficacy in benzodiazepine-refractory status epilepticus 2
For Chronic Epilepsy Management
Treatment should be initiated at 1000 mg/day given as twice-daily dosing (500 mg twice daily), with incremental increases of 1000 mg/day every 2 weeks to a maximum of 3000 mg/day. 1
- For partial-onset seizures: 500-1500 mg every 12 hours 1
- For myoclonic seizures: Target dose of 3000 mg/day (1500 mg twice daily) 1
- For primary generalized tonic-clonic seizures: Target dose of 3000 mg/day (1500 mg twice daily) 1
Renal Dose Adjustments
Levetiracetam requires dose adjustment based on creatinine clearance, with both dosage and frequency modifications in renal impairment. 1
| Creatinine Clearance | Dosage | Frequency |
|---|---|---|
| >80 mL/min (Normal) | 500-1500 mg | Every 12 hours |
| 50-80 mL/min (Mild) | 500-1000 mg | Every 12 hours |
| 30-50 mL/min (Moderate) | 250-750 mg | Every 12 hours |
| <30 mL/min (Severe) | 250-500 mg | Every 12 hours |
| ESRD on dialysis | 500-1000 mg | Every 24 hours* |
*Following dialysis, a 250-500 mg supplemental dose is recommended. 1
Administration Considerations
Standard Administration
The FDA-approved method is infusion over 15 minutes via IV piggyback. 1
Rapid Administration (Off-Label)
Rapid IV push administration over 5 minutes of undiluted levetiracetam (up to 100 mg/mL concentration) has been demonstrated safe in both adults and pediatric patients, with doses up to 4500 mg studied. 4, 5
- Pediatric doses up to 1500 mg administered as undiluted IVP over 5 minutes showed similar adverse event rates (5.5%) compared to standard infusion (7.5%) 6
- Rapid administration significantly reduces time to medication delivery (23 minutes vs 50 minutes for standard infusion) 6
- Most common adverse effects with rapid administration include injection site pain and agitation 4
- No cardiac monitoring is required, unlike phenytoin/fosphenytoin 2
Critical Safety Points
- Do not administer via intramuscular route - levetiracetam injection is for intravenous use only 1
- Avoid abrupt withdrawal to reduce risk of increased seizure frequency and status epilepticus 1
- No further dilution required - single-dose bags are ready to use 1
- Discard unused portions - these are single-dose containers 1
- Compatible with lorazepam, diazepam, and valproate sodium for at least 24 hours when mixed 1