cacy have not been established. A mean dose of 50.4 mg/kg/day IV was used in a small retrospective review of 10 pediatric patients ranging in age from 3 weeks to 19 years for a variety of seizure disorders or prophylaxis. Three of the 10 patients were receiving oral levetiracetam prior to presentation and received IV therapy temporarily due to an inability to continue oral therapy because of an intercurrent illness. For those patients, the IV dosage used was equivalent to their previous oral regimen. For acute repetitive seizures or SE, levetiracetam was administered every 8 hours in infants and every 12 hours in older children; for maintenance or prophylactic therapy, an every 12 hours dosage schedule was used for all patients. No adverse effects were reported. The authors note that the majority of patients were very ill, and therefore adverse effects such as sedation or behavioral problems may have been overlooked.
For the first-line treatment of convulsive status epilepticus†.
Intravenous dosage
Adults
20 mg/kg IV over 15 minutes. Clinical practice guidelines include levetiracetam as urgent control antiepileptic drug (AED) therapy, where goal is to quickly achieve therapeutic concentrations of AED and establish maintenance therapy in patients responding to initial emergent therapy or to abate seizures in patients who fail to respond to initial emergent therapy.
For seizure prophylaxis†.
For seizure prophylaxis† after traumatic brain injury.
Intravenous dosage
Adults
500 to 1000 mg IV every 12 hours for 7 days; adjust as needed for clinical effect up to Max: 3000 mg/day. A 20 mg/kg IV loading dose may be considered. Clinical practice guidelines support anticonvulsant use to prevent early post traumatic seizures, within 7 days of injury.
†Indicates off-label use
MAXIMUM DOSAGE
Adults
3000 mg/day PO or IV.
Geriatric
3000 mg/day PO or IV.
Adolescents
>= 16 years: 3000 mg/day PO or IV.
< 16 years: 60 mg/kg/day PO or IV (Max: 3000 mg/day).
Children
4—12 years: 60 mg/kg/day PO or IV (Max: 3000 mg/day).
< 4 years: 50 mg/kg/day PO or IV.
Infants
6—11 months: 50 mg/kg/day PO or IV.
1—5 months: 42 mg/kg/day PO or IV.
Neonates
Safety and efficacy have not been established.
DOSING CONSIDERATIONS
Hepatic Impairment
According to the manufacturer's labeling, no dosage adjustment is necessary in patients with hepatic impairment unless decreased renal function is also present, in which case the adjustment for renal dysfunction should be followed. Serum creatinine may not always be a reliable indicator for renal function in severe liver disease. Levetiracetam is not extensively metabolized by the liver. According to an in-vivo pharmacokinetic study, patients with severe hepatic impairment (Child-Pugh Class C) should initially receive one-half of the recommended dose.
Renal Impairment
In order to calculate the dose recommended for adults with renal impairment, creatinine clearance adjusted for body surface area (BSA) must be calculated using the following equations; children with renal impairment also need modified dosages but no quantitative recommendations are available:
CrCl = [140 - age (years)] x weight (kg)/72 x serum creatinine (mg/dl) (x 0.85 for females) then adjust for BSA
CrCl (ml/min/1.73m2) = [CrCl (ml/min)/BSA (m2)] x 1.73
Dosage adjustments for adults with impaired renal function are as follows:
CrCl > 80 ml/min: No dosage adjustment ne |
