Antiepileptic — Second-Line Status Epilepticus Pregnancy: Use with caution — relatively safer AED in pregnancy than valproate or phenytoin

Levetiracetam IV (Status Epilepticus)

Brand names: Keppra IV

Adult dose

Dose: 60 mg/kg IV (max 4500 mg) over 10 minutes

Route: IV

Frequency: Single loading dose

Max: 4500 mg single dose

Second-line treatment for established status epilepticus (after benzodiazepines). STELUS trial (2019): levetiracetam 60 mg/kg IV non-inferior to valproate and phenytoin. Advantages over phenytoin: no cardiac monitoring required, fewer drug interactions, safer in hepatic impairment.

Paediatric dose

Dose: 60 mg/kg

Route: IV

Frequency: Single loading dose

Max: 3000 mg

60 mg/kg IV over 15 minutes (max 3000 mg). Children ≥1 month.

Dose adjustments

Renal

Reduce dose if eGFR <80 mL/min — renally cleared.

Hepatic

No adjustment required — not hepatically metabolised.

Paediatric weight-based calculator

Patient weight (kg)

60 mg/kg IV over 15 minutes (max 3000 mg). Children ≥1 month.

Clinical pearls

STELUS and ESETT trials: levetiracetam, valproate, and fosphenytoin equally effective (~50% seizure termination) as second-line agents in status epilepticus. Levetiracetam has best safety profile.
No cardiac monitoring required unlike phenytoin — significant practical advantage in emergency setting
If already on oral levetiracetam: IV dose can be given as a supplementary dose

Contraindications

Hypersensitivity to levetiracetam

Side effects

Behavioural disturbance (agitation — more common IV)
Somnolence
Dizziness
Injection site reactions

Interactions

Minimal — no significant CYP450 interactions

Monitoring

Continuous EEG monitoring in refractory status
Seizure cessation assessment at 20 minutes post-dose
Renal function

Reference: BNFc; BNF 90; STELUS Trial; ESETT Trial (NEJM 2019); NICE NG217; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways