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Antiepileptic Pregnancy: Use if benefit outweighs risk; register with pregnancy registry.

Levetiracetam

Brand names: Keppra, Desitrend

Adult dose

Dose: 500 mg twice daily (maintenance); 2000–4000 mg IV for status epilepticus
Route: Oral or IV
Frequency: Twice daily (maintenance); IV over 15 min for acute seizures
Max: 3000 mg/day (maintenance); 60 mg/kg in status epilepticus
Status epilepticus (second-line): 60 mg/kg IV (max 4500 mg) over 10 minutes. Maintenance: start 500 mg BD, titrate by 500 mg BD every 2–4 weeks to max 1500 mg BD.

Paediatric dose

Dose: 10 mg/kg
Route: Oral or IV
Frequency: Twice daily
Max: 1500 mg/dose (maintenance); 60 mg/kg in status epilepticus
Concentration: 100 mg/ml
1 month–17 years: 10 mg/kg twice daily, increasing to 30 mg/kg twice daily. Status epilepticus: 60 mg/kg IV (max 4500 mg) over 10 minutes.

Dose adjustments

Renal

Reduce dose if eGFR <80 mL/min; max 1000 mg BD if eGFR <30 mL/min.

Hepatic

No dose adjustment required for mild-moderate impairment.

Paediatric weight-based calculator

1 month–17 years: 10 mg/kg twice daily, increasing to 30 mg/kg twice daily. Status epilepticus: 60 mg/kg IV (max 4500 mg) over 10 minutes.

Clinical pearls

  • Preferred IV antiepileptic for status epilepticus in many UK centres
  • Does not require therapeutic drug monitoring routinely
  • Behavioural side effects more common in children — counsel families
  • No significant pharmacokinetic interactions with other AEDs

Contraindications

  • Hypersensitivity to levetiracetam or pyrrolidone derivatives

Side effects

  • Somnolence
  • Headache
  • Nasopharyngitis
  • Behavioural changes (irritability, aggression — especially in children)
  • Depression
  • Dizziness
  • Asthenia

Interactions

  • Probenecid — increases levetiracetam levels
  • Methotrexate — levetiracetam may increase levels

Monitoring

  • Seizure frequency
  • Mood and behaviour (especially children)
  • Renal function

Reference: BNFc; BNF; NICE CG137; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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