Drug Detail:Keppra (Levetiracetam (oral/injection) [ lee-ve-tye-ra-se-tam ])
Generic Name: LEVETIRACETAM 250mg
Dosage Form: tablets and oral solution
Drug Class: Pyrrolidine anticonvulsants
Important Administration Instructions
KEPPRA is given orally with or without food. The KEPPRA dosing regimen depends on the indication, age group, dosage form (tablets or oral solution), and renal function.
Prescribe the oral solution for pediatric patients with body weight ≤ 20 kg. Prescribe the oral solution or tablets for pediatric patients with body weight above 20 kg.
When using the oral solution in pediatric patients, dosing is weight-based (mg per kg) using a calibrated measuring device (not a household teaspoon or tablespoon).
KEPPRA tablets should be swallowed whole. KEPPRA tablets should not be chewed or crushed.
Dosing for Partial-Onset Seizures
The recommended dosing for monotherapy and adjunctive therapy is the same; as outlined below.
Adults 16 Years of Age and Older
Initiate treatment with a daily dose of 1000 mg/day, given as twice-daily dosing (500 mg twice daily). 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.
Pediatric Patients
1 Month to < 6 Months
Initiate treatment with a daily dose of 14 mg/kg in 2 divided doses (7 mg/kg twice daily). Increase the daily dose every 2 weeks by increments of 14 mg/kg to the recommended daily dose of 42 mg/kg (21 mg/kg twice daily). In the clinical trial, the mean daily dose was 35 mg/kg in this age group.
6 Months to < 4 Years:
Initiate treatment with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg twice daily). Increase the daily dose in 2 weeks by an increment of 20 mg/kg to the recommended daily dose of 50 mg/kg (25 mg/kg twice daily). If a patient cannot tolerate a daily dose of 50 mg/kg, the daily dose may be reduced. In the clinical trial, the mean daily dose was 47 mg/kg in this age group.
4 Years to < 16 Years
Initiate treatment with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg twice daily). Increase the daily dose every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg twice daily). If a patient cannot tolerate a daily dose of 60 mg/kg, the daily dose may be reduced. In the clinical trial, the mean daily dose was 44 mg/kg. The maximum daily dose was 3000 mg/day.
For KEPPRA tablet dosing in pediatric patients weighing 20 to 40 kg, initiate treatment with a daily dose of 500 mg given as twice daily dosing (250 mg twice daily). Increase the daily dose every 2 weeks by increments of 500 mg to a maximum recommended daily dose of 1500 mg (750 mg twice daily).
For KEPPRA tablet dosing in pediatric patients weighing more than 40 kg, initiate treatment with a daily dose of 1000 mg/day given as twice daily dosing (500 mg twice daily). Increase the daily dose every 2 weeks by increments of 1000 mg/day to a maximum recommended daily dose of 3000 mg (1500 mg twice daily).
KEPPRA Oral Solution Weight-Based Dosing Calculation For Pediatric Patients
The following calculation should be used to determine the appropriate daily dose of oral solution for pediatric patients:
| Total daily dose (mL/day) = | Daily dose (mg/kg/day) × patient weight (kg) ------------------------------------------------ 100 mg/mL |
Dosing for Myoclonic Seizures in Patients 12 Years of Age and Older with Juvenile Myoclonic Epilepsy
Initiate treatment with a dose of 1000 mg/day, given as twice-daily dosing (500 mg twice daily). Increase the dosage by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been studied.
Dosing for Primary Generalized Tonic-Clonic Seizures
Adults 16 Years of Age and Older
Initiate treatment with a dose of 1000 mg/day, given as twice-daily dosing (500 mg twice daily). Increase dosage by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been adequately studied.
Pediatric Patients 6 to <16 Years of Age
Initiate treatment with a daily dose of 20 mg/kg in 2 divided doses (10 mg/kg twice daily). Increase the daily dose every 2 weeks by increments of 20 mg/kg to the recommended daily dose of 60 mg/kg (30 mg/kg twice daily). The effectiveness of doses lower than 60 mg/kg/day has not been adequately studied. Patients with body weight ≤20 kg should be dosed with oral solution. Patients with body weight above 20 kg can be dosed with either tablets or oral solution [see Dosage and Administration (2.1)]. Only whole tablets should be administered.
Dosage Adjustments in Adult Patients with Renal Impairment
KEPPRA dosing must be individualized according to the patient's renal function status. Recommended dosage adjustments for adults are shown in Table 1. In order to calculate the dose recommended for patients with renal impairment, creatinine clearance adjusted for body surface area must be calculated. To do this an estimate of the patient's creatinine clearance (CLcr) in mL/min must first be calculated using the following formula:
| CLcr= | [140-age (years)] × weight (kg) ---------------------------------------- 72 × serum creatinine (mg/dL) |
(× 0.85 for female patients) |
Then CLcr is adjusted for body surface area (BSA) as follows:
| CLcr (mL/min/1.73m2)= | CLcr (mL/min) ------------------------------ BSA subject (m2) |
× 1.73 |
| Group | Creatinine Clearance (mL/min/1.73m2) |
Dosage (mg) | Frequency |
|---|---|---|---|
|
|||
| Normal | > 80 | 500 to 1,500 | Every 12 hours |
| Mild | 50 – 80 | 500 to 1,000 | Every 12 hours |
| Moderate | 30 – 50 | 250 to 750 | Every 12 hours |
| Severe | < 30 | 250 to 500 | Every 12 hours |
| ESRD patients using dialysis | ---- | 500 to 1,000* | Every 24 hours* |
