What is the recommended Levetiracetam (Keppra) dosing for seizure disorders?

From the Guidelines

The recommended loading dose for Keppra (levetiracetam) in adults with seizure disorders is 1,500 mg orally, with rapid IV loading also safe and well tolerated in doses up to 60 mg/kg. This dosing strategy is based on the most recent and highest quality evidence available, as outlined in the study published in the Annals of Emergency Medicine in 2014 1. The study provides a comprehensive overview of loading dose and route of administration strategies for antiepileptic medications, including Keppra, in the emergency department setting.

Key Considerations

• The loading dose of 1,500 mg orally is a commonly recommended starting point for adults with seizure disorders, as it has been shown to be effective in achieving therapeutic levels quickly 1.
• Rapid IV loading of Keppra is also a viable option, with doses up to 60 mg/kg considered safe and well tolerated 1.
• It is essential to note that the choice of administration route (oral versus parenteral) ultimately depends on 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.

Additional Guidance

• For ongoing management, the usual starting dose of Keppra is 500 mg twice daily, which can be increased by 1000 mg/day every two weeks as needed, up to a maximum of 3000 mg/day.
• Dosing for children is weight-based, starting at 10 mg/kg twice daily and increasing to 20-30 mg/kg twice daily.
• Elderly patients or those with renal impairment may require dose adjustments, and Keppra should be taken consistently at the same times each day to maintain stable blood levels.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Levetiracetam is indicated as adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. Partial Onset Seizures Adults 16 Years And Older In clinical trials, daily doses of 1000 mg, 2000 mg, and 3000 mg, given as twice-daily dosing, were shown to be effective Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg BID) Additional dosing increments may be given (1000 mg/day additional every 2 weeks) to a maximum recommended daily dose of 3000 mg. Pediatric Patients Ages 4 To <16 Years Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID). The daily dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID). Myoclonic Seizures In Patients 12 Years Of Age And Older With Juvenile Myoclonic Epilepsy Treatment should be initiated with a dose of 1000 mg/day, given as twice-daily dosing (500 mg BID). Dosage should be increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg. Primary Generalized Tonic-Clonic Seizures Adults 16 Years And Older Treatment should be initiated with a dose of 1000 mg/day, given as twice-daily dosing (500 mg BID). Dosage should be increased by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg. Pediatric Patients Ages 6 To <16 Years Treatment should be initiated with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg BID). The daily dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg BID).

The recommended Keppra (levetiracetam) dosing for seizure disorders is as follows:

• Partial onset seizures:
  • Adults (16 years and older): 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with increments of 1000 mg/day every 2 weeks.
  • Pediatric patients (4 to <16 years): 20 mg/kg/day to 60 mg/kg/day, given as twice-daily dosing, with increments of 20 mg/kg every 2 weeks.
• Myoclonic seizures:
  • Patients (12 years and older): 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with increments of 1000 mg/day every 2 weeks.
• Primary generalized tonic-clonic seizures:
  • Adults (16 years and older): 1000 mg/day to 3000 mg/day, given as twice-daily dosing, with increments of 1000 mg/day every 2 weeks.
  • Pediatric patients (6 to <16 years): 20 mg/kg/day to 60 mg/kg/day, given as twice-daily dosing, with increments of 20 mg/kg every 2 weeks. 2

From the Research

Recommended Keppra Dosing for Seizure Disorders

There is limited information available on the recommended Keppra dosing for seizure disorders in the provided studies. However, the following information can be gathered:

• The effective terminal dose of levetiracetam (Keppra) was 1000mg in a study comparing its efficacy with valproate and lamotrigine in patients with juvenile myoclonic epilepsy 3.
• Levetiracetam is recommended as a first-line treatment for focal seizures and generalized epilepsy with tonic-clonic seizures, suitable for all age groups and both men and women 4.
• The study comparing levetiracetam and lamotrigine as first-line antiseizure medication in female patients with idiopathic generalized epilepsy does not provide specific dosing information, but suggests that levetiracetam may be associated with a reduced risk of treatment failure in patients with juvenile myoclonic epilepsy 5.

Key Findings

• Levetiracetam and sodium valproate have similar efficacy in treating juvenile myoclonic epilepsy, but levetiracetam may be a better alternative for women of childbearing age due to its lower risk of adverse effects 3.
• Levetiracetam is a recommended first-line treatment for focal seizures and generalized epilepsy with tonic-clonic seizures 4.
• Levetiracetam may be associated with a reduced risk of treatment failure in patients with juvenile myoclonic epilepsy, but further studies are needed to confirm its effectiveness in other idiopathic generalized epilepsy syndromes 5.

Comparison with Other Medications

• Levetiracetam has been compared with lamotrigine and sodium valproate in several studies, with varying results:

• Levetiracetam and sodium valproate have similar efficacy in treating juvenile myoclonic epilepsy, but levetiracetam may be a better alternative for women of childbearing age 3.
• Levetiracetam may be associated with a reduced risk of treatment failure in patients with juvenile myoclonic epilepsy, compared to lamotrigine 5.
• Lamotrigine, levetiracetam, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures 6.