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Levetiracetam Dosage

Applies to the following strength(s): 100 mg/mL ; 250 mg ; 500 mg ; 750 mg ; 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

PARTIAL ONSET SEIZURES:
-IV: 1000 mg daily given as 500 mg 2 times a day: increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. There is no evidence that doses greater than 3000 mg/day confer additional benefit.
-ORAL IMMEDIATE-RELEASE: 1000 mg daily given as 500 mg 2 times a day; increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. There is no evidence that doses greater than 3000 mg/day confer additional benefit.
-ORAL EXTENDED-RELEASE: 1000 mg once a day; increase in increments of 1000 mg every 2 weeks to the maximum daily dose of 3000 mg

MYOCLONIC SEIZURES IN PATIENTS WITH JUVENILE MYOCLONIC EPILEPSY:
-IV: 1000 mg daily given as 500 mg 2 times a day; increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.
-ORAL IMMEDIATE-RELEASE: 1000 mg/day, given as twice daily dosing (500 mg 2 times a day); increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg/day. The effectiveness of doses lower than 3000 mg/day has not been studied.

PRIMARY GENERALIZED TONIC-CLONIC SEIZURES:
IV: 1000 mg daily given as 500 mg 2 times a day; increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.
-ORAL IMMEDIATE-RELEASE: 1000 mg/day, given as twice daily dosing (500 mg 2 times a day); increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.

Uses:
-Adjunct therapy in the treatment of partial onset seizures in patients with epilepsy
-Adjunctive therapy in the treatment of juvenile myoclonic epilepsy
-Adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients with idiopathic generalized epilepsy

Usual Adult Dose for Seizures

PARTIAL ONSET SEIZURES:
-IV: 1000 mg daily given as 500 mg 2 times a day: increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. There is no evidence that doses greater than 3000 mg/day confer additional benefit.
-ORAL IMMEDIATE-RELEASE: 1000 mg daily given as 500 mg 2 times a day; increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. There is no evidence that doses greater than 3000 mg/day confer additional benefit.
-ORAL EXTENDED-RELEASE: 1000 mg once a day; increase in increments of 1000 mg every 2 weeks to the maximum daily dose of 3000 mg

MYOCLONIC SEIZURES IN PATIENTS WITH JUVENILE MYOCLONIC EPILEPSY:
-IV: 1000 mg daily given as 500 mg 2 times a day; increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.
-ORAL IMMEDIATE-RELEASE: 1000 mg/day, given as twice daily dosing (500 mg 2 times a day); increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg/day. The effectiveness of doses lower than 3000 mg/day has not been studied.

PRIMARY GENERALIZED TONIC-CLONIC SEIZURES:
IV: 1000 mg daily given as 500 mg 2 times a day; increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.
-ORAL IMMEDIATE-RELEASE: 1000 mg/day, given as twice daily dosing (500 mg 2 times a day); increase in increments of 1000 mg/day every 2 weeks to the maximum daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.

Uses:
-Adjunct therapy in the treatment of partial onset seizures in patients with epilepsy
-Adjunctive therapy in the treatment of juvenile myoclonic epilepsy
-Adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients with idiopathic generalized epilepsy

Usual Pediatric Dose for Epilepsy

PARTIAL ONSET SEIZURES:
-IV:
1 month to less than 6 months: 7 mg/kg 2 times a day; increase by 7 mg/kg 2 times a day every 2 weeks to maximum dose of 21 mg/kg 2 times a day
6 months to less than 4 years: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to maximum dose of 25 mg/kg 2 times a day
4 years to less than 16 years: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to maximum dose of 30 mg/kg 2 times a day
16 years and older: Refer to adult dosing
-ORAL IMMEDIATE-RELEASE:
4 to less than 16 years old: 10 mg/kg/dose orally 2 times a day; increase every 2 weeks by 10 mg/kg/dose to the maximum dose of 30 mg/kg 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. Patients with body weight 20 kg or less should be dosed with the oral solution. Patients with body weight above 20 kg can be dosed with either tablets or oral solution.
-FILM COATED TABLETS:
1 MONTH TO LESS THAN 6 MONTHS: 7 mg/kg 2 times a day; increase by 7 mg/kg 2 times a day every 2 weeks to recommended dose of 21 mg/kg 2 times a day
6 MONTHS TO LESS THAN 4 YEARS: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to recommended dose of 25 mg/kg 2 times a day
4 YEARS TO LESS THAN 16 YEARS: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to recommended dose of 30 mg/kg 2 times a day
PEDIATRIC PATIENTS WEIGHING 20 TO 40 KG: Initiate treatment with a daily dose of 500 mg given as twice daily dosing (250 mg 2 times a day). Increase the daily dose every 2 weeks by increments of 500 mg to a maximum recommended daily dose of 1500 mg (750 mg 2 timed a day).
PEDIATRIC PATIENTS WEIGHING MORE THAN 40 KG: Initiate treatment with a daily dose of 1000 mg/day given as twice daily dosing (500 mg 2 times a day). Increase the daily dose every 2 weeks by increments of 1000 mg/day to a maximum recommended daily dose of 3000 mg (1500 mg 2 times a day).

-MYOCLONIC SEIZURES IN PEDIATRIC PATIENTS 12 YEARS AND OLDER: See Adult Dosing

PRIMARY GENERALIZED TONIC-CLONIC SEIZURES:
-IV:
6 years to less than 16 years: 10 mg/kg 2 times a day, increase in increments of 10 mg/kg 2 times a day every 2 weeks to recommended dose of 30 mg/kg 2 times a day. The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied.
16 years and older: See Adult Dosing
-ORAL IMMEDIATE-RELEASE:
6 YEARS TO LESS THAN 16 YEARS: 10 mg/kg 2 times a day, increase in increments of 10 mg/kg 2 times a day every 2 weeks to recommended dose of 30 mg/kg 2 times a day. The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied. Patients with body weight 20 kg or less should be dosed with oral solution. Patients with body weight above 20 kg can be dosed with either tablets or oral solution.
16 YEARS AND OLDER: See Adult Dosing

Comments:
-Only whole tablets should be given.
-The oral solution should be used in pediatric patients with body weight of 20 kg or less.
-For pediatric patients, use weight-based dosing for the oral solution with a calibrated measuring device (not a household teaspoon or tablespoon)

Uses:
-Monotherapy in the treatment of partial onset seizures with or without secondary generalization in patients 16 years and older with newly diagnosed epilepsy
-Adjunctive therapy in the treatment of partial onset seizures with or without secondary generalization in patients with epilepsy
-Adjunctive therapy in the treatment of myoclonic seizures in patients with juvenile myoclonic epilepsy
-Adjunctive therapy in the treatment of primary generalized tonic-clonic seizures with idiopathic generalized epilepsy

Usual Pediatric Dose for Seizures

PARTIAL ONSET SEIZURES:
-IV:
1 month to less than 6 months: 7 mg/kg 2 times a day; increase by 7 mg/kg 2 times a day every 2 weeks to maximum dose of 21 mg/kg 2 times a day
6 months to less than 4 years: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to maximum dose of 25 mg/kg 2 times a day
4 years to less than 16 years: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to maximum dose of 30 mg/kg 2 times a day
16 years and older: Refer to adult dosing
-ORAL IMMEDIATE-RELEASE:
4 to less than 16 years old: 10 mg/kg/dose orally 2 times a day; increase every 2 weeks by 10 mg/kg/dose to the maximum dose of 30 mg/kg 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. Patients with body weight 20 kg or less should be dosed with the oral solution. Patients with body weight above 20 kg can be dosed with either tablets or oral solution.
-FILM COATED TABLETS:
1 MONTH TO LESS THAN 6 MONTHS: 7 mg/kg 2 times a day; increase by 7 mg/kg 2 times a day every 2 weeks to recommended dose of 21 mg/kg 2 times a day
6 MONTHS TO LESS THAN 4 YEARS: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to recommended dose of 25 mg/kg 2 times a day
4 YEARS TO LESS THAN 16 YEARS: 10 mg/kg 2 times a day; increase by 10 mg/kg 2 times a day every 2 weeks to recommended dose of 30 mg/kg 2 times a day
PEDIATRIC PATIENTS WEIGHING 20 TO 40 KG: Initiate treatment with a daily dose of 500 mg given as twice daily dosing (250 mg 2 times a day). Increase the daily dose every 2 weeks by increments of 500 mg to a maximum recommended daily dose of 1500 mg (750 mg 2 timed a day).
PEDIATRIC PATIENTS WEIGHING MORE THAN 40 KG: Initiate treatment with a daily dose of 1000 mg/day given as twice daily dosing (500 mg 2 times a day). Increase the daily dose every 2 weeks by increments of 1000 mg/day to a maximum recommended daily dose of 3000 mg (1500 mg 2 times a day).

-MYOCLONIC SEIZURES IN PEDIATRIC PATIENTS 12 YEARS AND OLDER: See Adult Dosing

PRIMARY GENERALIZED TONIC-CLONIC SEIZURES:
-IV:
6 years to less than 16 years: 10 mg/kg 2 times a day, increase in increments of 10 mg/kg 2 times a day every 2 weeks to recommended dose of 30 mg/kg 2 times a day. The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied.
16 years and older: See Adult Dosing
-ORAL IMMEDIATE-RELEASE:
6 YEARS TO LESS THAN 16 YEARS: 10 mg/kg 2 times a day, increase in increments of 10 mg/kg 2 times a day every 2 weeks to recommended dose of 30 mg/kg 2 times a day. The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied. Patients with body weight 20 kg or less should be dosed with oral solution. Patients with body weight above 20 kg can be dosed with either tablets or oral solution.
16 YEARS AND OLDER: See Adult Dosing

Comments:
-Only whole tablets should be given.
-The oral solution should be used in pediatric patients with body weight of 20 kg or less.
-For pediatric patients, use weight-based dosing for the oral solution with a calibrated measuring device (not a household teaspoon or tablespoon)

Uses:
-Monotherapy in the treatment of partial onset seizures with or without secondary generalization in patients 16 years and older with newly diagnosed epilepsy
-Adjunctive therapy in the treatment of partial onset seizures with or without secondary generalization in patients with epilepsy
-Adjunctive therapy in the treatment of myoclonic seizures in patients with juvenile myoclonic epilepsy
-Adjunctive therapy in the treatment of primary generalized tonic-clonic seizures with idiopathic generalized epilepsy

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:
ORAL IMMEDIATE RELEASE/IV:
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 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)

-Pediatric patients: Data not available

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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