Keppra Dosage Considerations
According to research that can be found in StatPearls Publishing Medical Journal Review, some reports of seizures have worsened in patients with higher Keppra doses. [1]
People may also discontinue using Keppra due to several causes, including the emergence of unfavorable adverse effects such as sleepiness, dizziness, or mood problems. Some people may find that Keppra may not effectively manage their seizures or that other drugs work better for their particular situation.
You should avoid abruptly stopping the drug to reduce the risk of increased seizure frequency and status epilepticus. Status seizures can last more than five minutes or two or more seizures within 5 minutes without the person returning to normal between them. It is a life-threatening medical emergency, particularly if treatment is delayed.
General Overview of Keppra Dosage for Adults Chart
| Purpose/Use | Dosage | Timeline |
|---|---|---|
| Seizure Prevention (Adults) | Initial: 500 mg twice daily Maintenance: 1000-3000 mg/day | Titration: Usually takes over a few weeks to reach an effective dose Ongoing, with periodic adjustments as needed |
| Seizure Prevention (Pediatric) | Initial: Weight-based dosing Maintenance: Weight-based | Titration: Similar gradual adjustment as in adults Ongoing, with periodic adjustments as needed |
| Status Epilepticus | Intravenous (IV) loading dose followed by oral maintenance doses | Immediate for IV, ongoing for maintenance |
| Myoclonic Seizures (Juvenile Myoclonic Epilepsy) | Similar to adult dosing. | Similar to adult dosing. |
| Primary Generalized Tonic-Clonic Seizures | Similar to adult dosing. | Similar to adult dosing. |
| Adjunctive Therapy in Epilepsy | Variable dosages based on individual needs | Ongoing, with adjustments as needed |
| Off-label Uses (e.g., Migraine, Neuropathic Pain) | Dosage may vary based on the condition | Individualized, with periodic assessments |
Proper Use of Keppra
An interprofessional team involving the clinician, nurse, and pharmacist assisting and educating the patient with the administration and regular drug dosing will result in the best patient outcome. Nurses can conduct initial screening, monitor disease progression, and assist with epilepsy management with Keppra therapy.
Here are helpful tips to take Keppra properly:
- Follow your healthcare professional’s prescription.
- Take with or without food.
- Swallow tablets whole; do not break or chew.
- Stay consistent with the dosing schedule.
- Avoid sudden discontinuation; consult a doctor.
- Notify the healthcare provider of side effects.
- Regularly monitor blood levels as advised.
- Inform the healthcare team of all medications.
- Keep track of seizure occurrences.
- Follow specific guidelines for liquid form.
Dosage adjustment is generally not needed for liver failure. However, there are reports that total body clearance of Keppra is reduced by half in severe liver disease (Child-Pugh C). Therefore, half of the recommended dose should be initiated in patients with severe liver cirrhosis. [2]
Keppra Breastfeeding Warning
If a mother needs Keppra, it is not necessarily a reason to discontinue breastfeeding. However, clinicians should monitor exclusively breastfed infants for developmental milestones, drowsiness, and weight gain.
According to research by the National Institute of Child Health and Human Development, Keppra might reduce some women’s maternal breast milk output. Therefore, maternal serum level monitoring and dosage adjustment are advised in the early postpartum period if the mother was administered Keppra throughout pregnancy and breastfeeding. [3]
Keppra is excreted in breast milk, but infant serum drug levels are low. Also, the Keppra concentration in milk can be high in some women and sometimes cause sedation in breastfed infants.
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What is Keppra Loading Dose?
Keppra (levetiracetam) loading dosage is given at a higher-than-normal dose to rapidly reach therapeutic levels in cases when fast seizure control is required. Like in the treatment of status epilepticus or when starting Keppra medication in some epileptic patients, this loading dosage is frequently employed.
A maintenance dosage—a smaller, regularly scheduled amount—must be administered after the loading dose to maintain therapeutic levels of the drug in the body over time. [4]
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Can Missing One Dose of Keppra Cause a Seizure?
Those who have been taking Keppra (levetiracetam) as directed for a consistent period are unlikely to experience a seizure even if they miss one dosage. But skipping a dosage might cause a brief drop in medication levels, which could raise the chance of breakthrough seizures, particularly in those who are already at risk for seizures.
It’s usually advised to take missing doses as soon as remembered if they occur accidentally. It usually is better to skip the missed dosage and stick to the regular dosing plan if the next scheduled dose is approaching. If there are questions concerning missing doses or modifications to the drug schedule, it is imperative to speak with a healthcare provider.
What is the Maximum Dose of Keppra for Adults?
For patients with epilepsy, the maximum daily dosage is often between 3000 and 4000 mg, split into two doses. However, a healthcare provider should consider the patient’s medical history and reaction to therapy when determining the precise dosage.
What Happens If You Take a Double Dose of Keppra?
Taking a double dose of Keppra (levetiracetam) may increase the risk of side effects associated with the medication, such as drowsiness, dizziness, and irritability.
Taking more than the recommended amount can lead to an overdose or an increased risk of adverse reactions.
Can You Overdose on Keppra?
In overdose, Keppra is sedating and causes respiratory depression. However, recovery is rapid with supportive care. Keppra overdose symptoms to watch out for include:
- Extreme drowsiness.
- Agitation.
- Loss of consciousness.
- Difficulty breathing.
- Confusion.
- Slurred speech.
- Weakness.
- Uncontrolled movements.
- Seizures (more frequent or severe).
- Coma.
If a double dose is accidentally taken, it is advisable to contact a healthcare provider for guidance, and in some cases, seeking medical attention may be necessary. Call 911 if you suspect someone is overdosing on Keppra.
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Drug discontinuation may be considered after a minimum of two years without a seizure. The risk of recurrence decreases with every additional year of seizure freedom. However, each person’s experience varies. An individualized approach is required to examine each patient’s risks and benefits thoroughly. In patients with an increased risk of seizure recurrence, it is advisable to wait longer than two years before considering antiepileptic drug discontinuation. [5]
The duration of the tapering period of Keppra varies greatly. It depends on multiple factors, such as:
- The number of antiepileptic medications.
- Starting dose.
- Previous seizure frequency.
- Seizure type and associated risk of injury.
- Risk of withdrawal seizures with some antiepileptic drugs.
- Non-driving period.
Patients on numerous antiepileptic drugs, including Keppra and benzodiazepines, need to withdraw them consecutively. A neurologist should plan the tapering schedule after discussing all relevant factors with the patient. The patient’s requirements and preferences will also influence the taper duration. A slow taper allows observation and helps to document the minimally effective doses in case the seizures recur. However, a slow taper prolongs the non-driving period.
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Sources
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- KEPPRA® (levetiracetam) – accessdata.fda.gov – Food and Drug Administration (FDA)
- Levetiracetam: MedlinePlus Drug Information – MedlinePlus (.gov)
- KEPPRA- levetiracetam tablet, film-coated & KEPPRA- levetiracetam solution – National Institutes of Health (NIH)
- LEVETIRACETAM INJ, SOLN – VA Formulary Advisor – Veterans Affairs (.gov)
