From the FDA Drug Label
Levetiracetam is indicated as adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. 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). Patients with body weight ≤20 kg should be dosed with oral solution. Patients with body weight above 20 kg can be dosed with either tablets or oral solution.
Keppra Pediatric Dosing:
- The recommended daily dose for pediatric patients is 20-60 mg/kg/day, divided into 2 doses.
- The dose should be increased every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg.
- Patients with body weight ≤20 kg should be dosed with oral solution, while patients with body weight above 20 kg can be dosed with either tablets or oral solution 1.
From the Research
Keppra (levetiracetam) is a highly effective and recommended antiepileptic medication for pediatric patients, with a starting dose of 10 mg/kg twice daily, which can be gradually increased to 20-60 mg/kg/day divided into two doses based on clinical response and tolerability, as supported by the most recent and highest quality study 2.
Key Considerations
- The medication is available in oral solution (100 mg/mL) for easier administration to young children and tablets (250 mg, 500 mg, 750 mg, and 1000 mg) for older children who can swallow pills.
- Common side effects include irritability, somnolence, and behavioral changes, which should be monitored closely in pediatric patients, as noted in 3 and 4.
- Parents should be advised not to discontinue the medication abruptly as this may trigger seizures.
- Keppra works by binding to the synaptic vesicle protein SV2A in the brain, which helps regulate neurotransmitter release and stabilize neuronal activity, making it effective for various seizure types in children, as explained in 5 and 4.
Monitoring and Follow-up
- Regular follow-up appointments are essential to monitor therapeutic response, adjust dosing as the child grows, and assess for any adverse effects.
- The choice of AED depends on factors such as efficacy, adverse effects, interactions, adherence, and mechanism of action, as discussed in 2.
Important Notes
- Levetiracetam has a novel structure and unique mechanisms of action, and is associated with rapid and complete absorption, high oral bioavailability, minimal metabolism, and primarily renal elimination, as described in 3 and 5.
- The medication is not associated with cognitive impairment or drug-induced weight gain, but has been associated with behavioral adverse effects in some patients, as noted in 3 and 4.