What is the maintenance dose of Levera (levetiracetam) tablets in children?

Maintenance Dose of Levetiracetam Tablets in Children

For routine epilepsy management in children, the standard maintenance dose of levetiracetam is 30 mg/kg twice daily (60 mg/kg/day total), which can be adjusted down to 20 mg/kg twice daily if the higher dose is not tolerated. 1

Standard Dosing by Indication

Partial Onset Seizures (Ages 4-16 years)

• Starting dose: 10 mg/kg twice daily (20 mg/kg/day total) 1
• Titration: Increase by 10 mg/kg twice daily (20 mg/kg/day total) every 2 weeks 1
• Target maintenance dose: 30 mg/kg twice daily (60 mg/kg/day total) 1
• If not tolerated: May reduce to lower dose, though the mean effective dose in clinical trials was 52 mg/kg/day 1

Primary Generalized Tonic-Clonic Seizures (Ages 6-16 years)

• Starting dose: 10 mg/kg twice daily (20 mg/kg/day total) 1
• Titration: Increase by 10 mg/kg twice daily every 2 weeks 1
• Target maintenance dose: 30 mg/kg twice daily (60 mg/kg/day total) 1
• Doses lower than 60 mg/kg/day have not been adequately studied for efficacy 1

Myoclonic Seizures (Ages 12+ years with Juvenile Myoclonic Epilepsy)

• Starting dose: 500 mg twice daily (1000 mg/day total) 1
• Titration: Increase by 500 mg twice daily (1000 mg/day total) every 2 weeks 1
• Target maintenance dose: 1500 mg twice daily (3000 mg/day total) 1

Weight-Based Tablet Dosing Guide

For children weighing 20.1 to 40 kg at target maintenance dose (60 mg/kg/day): 1

• 1 × 750 mg tablet twice daily (1500 mg/day total)

For children weighing >40 kg at target maintenance dose (60 mg/kg/day): 1

• 2 × 750 mg tablets twice daily (3000 mg/day total)

Children ≤20 kg should use oral solution rather than tablets. 1

Special Situations

Status Epilepticus Maintenance (After Acute Management)

For convulsive status epilepticus: 2

• 30 mg/kg IV every 12 hours (maximum 1500 mg per dose), OR
• Increase prophylaxis dose by 10 mg/kg (to 20 mg/kg) IV every 12 hours (maximum 1500 mg)

For non-convulsive status epilepticus: 2

• 15 mg/kg IV every 12 hours (maximum 1500 mg per dose)

Seizure Prophylaxis (e.g., CAR T-cell therapy)

• 10 mg/kg every 12 hours (maximum 500 mg per dose) for 30 days 3
• This is a prophylactic dose, not a treatment dose for active seizures

Pharmacokinetic Considerations

Children require higher weight-normalized doses than adults because: 4, 5

• Apparent body clearance is 30-40% higher in children than adults
• The most influential covariate affecting levetiracetam pharmacokinetics in children is bodyweight
• A starting dose of 10 mg/kg twice daily in children achieves similar exposure to 500 mg twice daily in adults

Enzyme-inducing antiepileptic drugs increase levetiracetam clearance, potentially requiring higher maintenance doses. 5

Higher Doses for Refractory Seizures

Some children with inadequate seizure control on standard doses may benefit from higher doses: 6

• Doses up to 70-275 mg/kg/day have been used safely in refractory cases
• 44% of children achieved >50% seizure reduction with high doses (median 146 mg/kg/day)
• 16% achieved seizure freedom
• Only 12% experienced adverse effects (primarily behavioral)

However, these high doses should be reserved for children who partially respond to standard doses and are not first-line recommendations. 6

Administration Guidelines

• Can be given with or without food 1
• Use a calibrated measuring device for oral solution, not household spoons 1
• Only whole tablets should be administered 1
• IV and oral formulations have equivalent bioavailability 7

Common Pitfalls

• Do not underdose based on adult weight-based calculations—children require higher mg/kg doses than adults to achieve equivalent drug exposure 4, 5
• Do not skip the titration schedule—rapid escalation increases the risk of behavioral adverse effects 1
• Do not use tablets in children ≤20 kg—oral solution provides more accurate dosing in this weight range 1
• Ensure adequate renal function assessment—levetiracetam requires dose adjustment in renal impairment 3