From the Guidelines
The recommended starting dose of Keppra (levetiracetam) is 1,500 mg oral load, as this has been shown to be safe and well-tolerated, with no seizures within 24 hours of loading in a study of oral loading 1. When initiating Keppra therapy, it is essential to consider the patient's individual needs and medical history. The oral loading dose of 1,500 mg can be used in the emergency department setting for patients with a known seizure disorder, as it has been found to be effective in preventing early recurrent seizure.
- Key points to consider when starting Keppra include:
- The oral loading dose is 1,500 mg, which can be administered as a single dose.
- Rapid IV loading is also safe and well-tolerated in doses up to 60 mg/kg.
- Common side effects include fatigue, dizziness, and rarely, pain at the infusion site.
- Keppra should be used with caution in patients with renal impairment, as dose adjustments may be necessary based on creatinine clearance. The choice of administration route, whether oral or parenteral, is at the discretion of the emergency physician, as there is currently a lack of evidence to support one route over the other in terms of preventing early recurrent seizure 1.
From the FDA Drug Label
Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID) Treatment should be initiated with a dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) The starting dose of Keppra (levetiracetam) is:
- 1000 mg/day (500 mg twice daily) for adults 16 years and older
- 20 mg/kg/day (10 mg/kg twice daily) for pediatric patients ages 4 to <16 years 2
From the Research
Keppra Starting Dose
- The starting dose of Keppra (levetiracetam) can vary depending on the patient population and renal function.
- In children with epilepsy, a weight-based dosing regimen is recommended, with a starting dose of 10mg/kg twice daily 3.
- For adults with normal renal function, a starting dose of 500mg twice daily is commonly used 4.
- However, in critically ill patients with normal or augmented renal clearance, higher doses may be needed to achieve therapeutic levels, such as 500mg every 8 hours or 1000mg every 12 hours 5, or even 1000mg twice daily 6.
- In patients undergoing continuous veno-venous hemofiltration (CVVH), standard doses of levetiracetam may be required to maintain adequate plasma concentrations due to the effective removal of the drug by CVVH 7.
Patient-Specific Factors
- Renal function is an important factor in determining the starting dose of Keppra, with patients having augmented renal clearance requiring higher doses 5, 6.
- Body weight is also a significant factor in children, with a weight-based dosing regimen recommended 3.
- Critically ill patients may require higher doses due to enhanced drug elimination 5, 6.
Dosing Regimens
- The following dosing regimens have been suggested:
- 10mg/kg twice daily for children with epilepsy 3
- 500mg twice daily for adults with normal renal function 4
- 500mg every 8 hours or 1000mg every 12 hours for critically ill patients with normal renal function 5
- 1000mg twice daily for critically ill patients with augmented renal clearance 6
- Standard doses for patients undergoing CVVH 7