Intermittent hemodialysis
In adults with end-stage renal disease (ESRD) receiving standard hemodialysis, administer 500 to 1000 mg PO or IV every 24 hours. A 250 to 500 mg supplemental PO or IV dose is recommended following dialysis. Standard hemodialysis results in a roughly 50% clearance of levetiracetam in 4 hours. The extended-release formulation should not be used in patients on dialysis.
ADMINISTRATION
Oral Administration
May be administered without regard to meals.
Oral Solid Formulations
Immediate-release tablets (Keppra):
Swallow whole; do not chew or crush.
Fast-melting tablets (Spritam)
Administer only whole tablets.
Peel the foil from the blister; do not attempt to push the tablet through the foil.
With dry hands, place the tablet on the tongue and follow with a sip of liquid. Swallow only after the tablet disintegrates; do not swallow the intact tablet. Spritam disintegrates in a mean time of 11 seconds (range, 2 to 27 seconds).
Alternatively, whole tablets can be added to a small volume of liquid (1 tablespoon or enough to cover the medicine) in a cup. Swirl gently. Consume the entire contents of the cup after the tablet has dispersed. If there is medicine left in the cup, add a small volume of liquid to the cup, swirl gently, and swallow the full amount. Do not attempt to administer partial quantities of the dispersed tablet.
Extended-release tablets (Keppra XR):
Swallow whole; do not break, chew, or crush.
The biologically inert components of this tablet may remain intact and appear as a soft, hydrated mass in the stool; this is normal.
Oral Liquid Formulations
Oral solution (100 mg/mL): Measure using a calibrated oral measuring device for accurate dosage administration. NOTE: Levetiracetam (Keppra) oral solution does not contain alcohol, dye, gluten, lactose, starch, sugar, or sucrose.
Injectable Administration
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
Dilute the dose in 100 mL of compatible diluent (0.9% Sodium Chloride Injection, Lactated Ringer's Injection, or 5% Dextrose Injection). A smaller volume may be used for pediatric or fluid-restricted patients; FDA-approved labeling does not recommend exceeding a maximum levetiracetam concentration of 15 mg/mL.
Infuse dose over 15 minutes.
Rapid administration of more concentrated solution has been studied in pediatric and young adult patients (age range: 4 to 32 years). Doses of 20 mg/kg (Max: 1,000 mg), 40 mg/kg (Max: 2,000 mg), or 60 mg/kg (Max: 3,000 mg) were diluted 1:1 with either 0.9% Sodium Chloride Injection or 5% Dextrose Injection and infused over 5 minutes (20 mg/kg and 40 mg/kg doses) or 6 min