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Levetiracetam Dosage

Applies to the following strength(s): 250 mg ; 500 mg ; 750 mg ; 100 mg/mL ; 1000 mg ; 500 mg/100 mL-NaCl 0.82% ; 1000 mg/100 mL-NaCl 0.75% ; 1500 mg/100 mL-NaCl 0.54%

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Epilepsy

16 years of age and older:
-Immediate-release oral or IV administration:
Initial Dose: 1000 mg orally daily given as 500 mg orally 2 times a day. Additional dosing increments may be given (1000 mg/day additional every 2 weeks) to a maximum recommended daily dose of 3000 mg. There is no evidence that doses greater than 3000 mg/day confer additional benefit.
-Extended-release oral:
Initial dose: 1000 mg orally once daily
This dose may be increased every 2 weeks by 1000 mg/day to a maximum of 3000 mg once daily.

Comments:
-This drug can be initiated with either IV or oral administration.
-The IV form of this drug is an alternative for adult patients (16 years and older) when oral administration is temporarily not feasible.

Uses:
-Partial Onset Seizures: As adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy (16 years and older for the IV formulation)
-Myoclonic Seizures in Patients with Juvenile Myoclonic Epilepsy: As adjunctive therapy in the treatment of myoclonic seizures in adults and children 12 years of age and older with juvenile myoclonic epilepsy (16 years and older for the IV formulation)
-Primary Generalized Tonic-Clonic Seizures: As adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy (16 years and older for the IV formulation)

Usual Adult Dose for Seizures

16 years of age and older:
-Immediate-release oral or IV administration:
Initial Dose: 1000 mg orally daily given as 500 mg orally 2 times a day. Additional dosing increments may be given (1000 mg/day additional every 2 weeks) to a maximum recommended daily dose of 3000 mg. There is no evidence that doses greater than 3000 mg/day confer additional benefit.
-Extended-release oral:
Initial dose: 1000 mg orally once daily
This dose may be increased every 2 weeks by 1000 mg/day to a maximum of 3000 mg once daily.

Comments:
-This drug can be initiated with either IV or oral administration.
-The IV form of this drug is an alternative for adult patients (16 years and older) when oral administration is temporarily not feasible.

Uses:
-Partial Onset Seizures: As adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy (16 years and older for the IV formulation)
-Myoclonic Seizures in Patients with Juvenile Myoclonic Epilepsy: As adjunctive therapy in the treatment of myoclonic seizures in adults and children 12 years of age and older with juvenile myoclonic epilepsy (16 years and older for the IV formulation)
-Primary Generalized Tonic-Clonic Seizures: As adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy (16 years and older for the IV formulation)

Usual Pediatric Dose for Epilepsy

Partial onset seizures:
Oral:
Children 4 to less than 16 years: Immediate release: 10 mg/kg/dose orally 2 times a day; may increase every 2 weeks by 10 mg/kg/dose to the recommended dose of 30 mg/kg/dose 2 times a day (60 mg/kg/daily). The daily dose of 60 mg/kg may be reduced in patients who cannot tolerate this dose.
Maximum dose: 3000 mg/day
Children 16 years and older: Refer to adult dosing

Myoclonic seizures:
Oral:
Children 12 years and older: Immediate release: Initial: 500 mg orally 2 times a day; may increase every 2 weeks by 500 mg/dose to the recommended dose of 1500 mg orally 2 times a day. Efficacy of doses greater than 3000 mg/day has not been established.
Children 16 years and older: Refer to adult dosing

Tonic-clonic seizures:
Oral:
Children 6 to less than 16 years: Immediate release: Initial: 10 mg/kg orally 2 times a day; may increase every 2 weeks by 10 mg/kg/dose to the recommended dose of 30 mg/kg 2 times a day. Efficacy of doses greater than 60 mg/kg/day has not been established.
Maximum dose: 3000 mg/day
Children 16 years and older: Refer to adult dosing

Uses:
-Partial Onset Seizures: As adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy (16 years and older for the IV formulation)
-Myoclonic Seizures in Patients with Juvenile Myoclonic Epilepsy: As adjunctive therapy in the treatment of myoclonic seizures in adults and children 12 years of age and older with juvenile myoclonic epilepsy (16 years and older for the IV formulation)
-Primary Generalized Tonic-Clonic Seizures: As adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy (16 years and older for the IV formulation)

Usual Pediatric Dose for Seizures

Partial onset seizures:
Oral:
Children 4 to less than 16 years: Immediate release: 10 mg/kg/dose orally 2 times a day; may increase every 2 weeks by 10 mg/kg/dose to the recommended dose of 30 mg/kg/dose 2 times a day (60 mg/kg/daily). The daily dose of 60 mg/kg may be reduced in patients who cannot tolerate this dose.
Maximum dose: 3000 mg/day
Children 16 years and older: Refer to adult dosing

Myoclonic seizures:
Oral:
Children 12 years and older: Immediate release: Initial: 500 mg orally 2 times a day; may increase every 2 weeks by 500 mg/dose to the recommended dose of 1500 mg orally 2 times a day. Efficacy of doses greater than 3000 mg/day has not been established.
Children 16 years and older: Refer to adult dosing

Tonic-clonic seizures:
Oral:
Children 6 to less than 16 years: Immediate release: Initial: 10 mg/kg orally 2 times a day; may increase every 2 weeks by 10 mg/kg/dose to the recommended dose of 30 mg/kg 2 times a day. Efficacy of doses greater than 60 mg/kg/day has not been established.
Maximum dose: 3000 mg/day
Children 16 years and older: Refer to adult dosing

Uses:
-Partial Onset Seizures: As adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy (16 years and older for the IV formulation)
-Myoclonic Seizures in Patients with Juvenile Myoclonic Epilepsy: As adjunctive therapy in the treatment of myoclonic seizures in adults and children 12 years of age and older with juvenile myoclonic epilepsy (16 years and older for the IV formulation)
-Primary Generalized Tonic-Clonic Seizures: As adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in adults and children 6 years of age and older with idiopathic generalized epilepsy (16 years and older for the IV formulation)

Renal Dose Adjustments

PEDIATRIC PATIENTS: The dosage should be adjusted according to renal function; however, no specific dose adjustment guidelines have been suggested.

ADULT PATIENTS:
IMMEDIATE RELEASE TABLETS:
CrCl greater than 80 mL/min: 500 to 1500 mg every 12 hours
CrCl 50 to 80 mL/min: 500 to 1000 every 12 hours
CrCl 30 to 50 mL/min: 250 to 750 mg every 12 hours
CrCl less than 30 mL/min: 250 to 500 mg every 12 hours
ESRD PATIENTS USING DIALYSIS: 500 to 1000 mg every 24 hours

ADULT PATIENTS:
EXTENDED RELEASE TABLETS:
CrCl greater than 80 mL/min: 1000 to 3000 mg every 24 hours
CrCl 50 to 80 mL/min: 1000 to 2000 mg every 24 hours
CrCl 30 to 50 mL/min: 500 to 1500 mg every 24 hours
CrCl less than 30 mL/min: 500 to 1000 mg every 24 hours

Liver Dose Adjustments

Data not available

Dose Adjustments

-Conversion to or from oral to intravenous administration can be done directly without titration. The total daily dose and frequency of administration should be maintained.
-This drug should be used at the lowest effective dose in order to achieve therapeutic efficacy and minimize adverse effects.
-If discontinuing this drug, the adult dose may be reduced in increments of 500 mg 2 times a day every 2 to 4 weeks. Pediatric dose reductions should not exceed 10 mg/kg twice daily every 2 weeks.

Precautions

Consult Pediatric Dosing and/or manufacturer information for age restrictions in pediatric dosing.

Consult WARNINGS section for additional precautions.

Dialysis

-The immediate release product should be used in end-stage renal disease patients using dialysis.
-Supplemental doses should be given to patients after dialysis.

-For adult patients: For end stage renal disease patients using dialysis: 500 to 1,000 mg dose every 24 hours
Following dialysis, a 250 to 500 mg supplemental dose is recommended
Standard hemodialysis procedures result in significant clearance of levetiracetam (approximately 50% in 4 hours)

-For pediatric patients:
Peritoneal Dialysis: Administer 50% of normal dose.

Other Comments

Administration advice:
-Only whole tablets should be administered.
-Film-coated tablets and oral solution may be administered with or without food.
-The oral solution may be diluted in water prior to administration.
-For pediatric patients weighing 20 kg or less, treatment should preferably be initiated with the oral solution.
-Switching between oral and IV therapy may be accomplished directly without titration; the total daily dose and frequency of administration should remain the same.
-The IV concentrate solution should be diluted in at least 100 mL of a compatible fluid and administered intravenously as a 15 minute infusion.

Compatibility/incompatibility:
-The IV concentrate solution is incompatible with phenytoin sodium in a polyvinyl chloride bag.
-The manufacturer product information should be consulted for a list of IV compatible antiepileptic drugs and diluents.

General:
-The clinician should prescribe the most appropriate pharmaceutical form, presentation and strength according to age, weight and dose.

Reconstitution/preparation techniques:
-The manufacturer's product information should be consulted.

Storage requirements:
-When mixed with one of the manufacturer recommended diluents and/or antiepileptic drugs, the IV solution may be stored for at least 24 hours in a PVC bag at controlled room temperature (15 to 30 degrees Celsius).
-If the IV solution is not used immediately after preparation it may be stored for not longer than 24 hours at 2 to 8 degrees Celsius.

Monitoring:
-Renal function should be assessed prior to dose selection in patients with severe liver dysfunction.

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