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Anticonvulsant (SV2A Ligand) Pregnancy: Caution — data suggests lower risk than older anticonvulsants; folic acid supplementation essential

Levetiracetam (Paediatric)

Brand names: Keppra

Adult dose

Dose: Starting: 250 mg BD. Increase by 250 mg BD every 2 weeks. Target: 1000–3000 mg/day
Route: Oral or IV
Frequency: BD
Max: 3000 mg/day
Full adult dosing in neurology section

Paediatric dose

Dose: 10 mg/kg
Route: Oral or IV
Frequency: BD
Max: 3000 mg per dose (max 60 mg/kg/day)
Concentration: 100 mg/mL oral solution; 500 mg/5 mL IV mg/ml
BNF for Children: starting 10 mg/kg BD. Increase by 10 mg/kg BD every 2 weeks to max 30 mg/kg BD (max 3 g BD). SE loading: 60 mg/kg IV (max 4500 mg) over 10 min (ECLIPSE trial). Licensed from 1 month. Source: BNF for Children 2024; ECLIPSE Trial (Lyttle, Lancet 2019); NICE NG217

Dose adjustments

Renal

Reduce dose if eGFR <50 — renally cleared

Hepatic

No dose adjustment required

Paediatric weight-based calculator

BNF for Children: starting 10 mg/kg BD. Increase by 10 mg/kg BD every 2 weeks to max 30 mg/kg BD (max 3 g BD). SE loading: 60 mg/kg IV (max 4500 mg) over 10 min (ECLIPSE trial). Licensed from 1 month. Source: BNF for Children 2024; ECLIPSE Trial (Lyttle, Lancet 2019); NICE NG217

Clinical pearls

  • ECLIPSE trial: levetiracetam IV as effective as phenytoin for convulsive SE in children (and better tolerated)
  • Behavioural side effects common in paediatric epilepsy — may require dose reduction or switch to alternative
  • No enzyme induction — does not affect OCP or other drug levels
  • Broad-spectrum: focal and generalised seizures, juvenile myoclonic epilepsy

Contraindications

  • None significant beyond hypersensitivity

Side effects

  • Behavioural disturbance (agitation, aggression, irritability — especially in children, up to 10%)
  • Somnolence
  • Headache
  • Reduced appetite
  • Rash (rare)
  • Psychosis (rare)

Interactions

  • Few significant drug interactions (no hepatic enzyme induction/inhibition)
  • Carbamazepine — may increase CNS toxicity of carbamazepine (pharmacodynamic)

Monitoring

  • Seizure frequency and type
  • Behavioural assessment (regular parent/teacher questionnaires)
  • Renal function (dose adjustment)
  • Mood and mental health

Reference: BNF for Children; ECLIPSE Trial (Lyttle et al, Lancet 2019); NICE NG217. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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