Levetiracetam

Status Epilepticus
Seizure Prophylaxis
1. Partial Seizures or Focal onset Seizures (FDA Approved for adjunctive therapy)
2. Juvenile Myoclonic Epilepsy (FDA approved for ages >12 years for adjunctive therapy)
3. Primary Generalized Tonic Clonic Seizures (FDA approved for ages >6 years for adjunctive therapy)
Myoclonus (adults, off label)

Broad spectrum Pyrrolidine anticonvulsant, with activity isolated to the synaptic plasma membrane of CNS Neurons
Decreases burst Neuron firing (and decreased Seizure propagation) without Neuron normal excitability
Binds Glycoprotein 2A at the synaptic Vesicle and may alter Vesicle fusion
May also affect Gamma-Aminobutyric Acid (GABA)

Dose: 60 mg/kg IV (or 2.5 g in adults, up to 4.5 g maximum) over 5 to 15 min for single dose

Target serum concentration: 12 to 46 mcg/ml
Immediate Release (Keppra, Spiritam)
1. Start: 500 mg orally or IV twice daily
2. Titrate every 2 weeks, increasing by 1000 mg/day divided twice daily
3. Typical target dose: 3000 mg/day (or 80 mg/kg/day) divided twice daily
4. Maximum: 3000 mg/day (higher doses do not increase efficacy)
Extended Release (Keppra XR for Partial Seizures)
1. Start 1000 mg orally daily
2. Titrate every 2 weeks, increasing by 1000 mg/day
3. Typical target dose: 3000 mg/day (or 80 mg/kg/day)
4. Maximum: 3000 mg/day (higher doses do not increase efficacy)
Intravenous infusion dose is bioequivalent to oral dose
1. Load: 20-30 mg/kg IV at 5 mg/kg/min

Age 1 to 6 months (Keppra Solution, oral dosing only)
1. Start 14 mg/kg/day divided orally twice daily
2. Increase every 2 weeks by 14 mg/kg/day divided twice daily
3. Target dose: 42 mg/kg/day divided twice daily
Age 6 months to 4 years (Keppra Solution, oral dosing only)
1. Start 20 mg/kg/day divided orally twice daily
2. Increase every 2 weeks by 20 mg/kg/day divided twice daily
3. Target dose: 50 mg/kg/day divided twice daily
Age 4 to 16 years (oral dosing only)
1. Keppra Solution
  1. Start 20 mg/kg/day divided orally twice daily
  2. Increase every 2 weeks by 20 mg/kg/day divided twice daily
  3. Target dose: 60 mg/kg/day divided twice daily
2. Keppra tablets: Weight 20 to 40 kg
  1. Start: 250 mg orally twice daily
  2. Titrate every 2 weeks, increasing by 500 mg/day divided twice daily
  3. Typical target dose: 1500 mg/day divided twice daily
  4. Maximum: 1500 mg/day
3. Keppra tablets: Weight >40 kg
  1. Start: 500 mg orally twice daily
  2. Titrate every 2 weeks, increasing by 1000 mg/day divided twice daily
  3. Typical target dose: 3000 mg/day divided twice daily
  4. Maximum: 3000 mg/day (higher doses do not increase efficacy)
Age >16 years
1. Use adult dosing (IV or oral)

Most common
1. Fatigue or Weakness
2. Somnolence
3. Dizziness or Vertigo
Psychiatric symptoms or Behavioral Changes (common, may limit usage)
1. Agitation or hostility
2. Emotional lability
3. Anxiety
4. Depressed mood
Other symptoms
1. Irritability
2. Rash