Update on Levetiracetam in Infants and Children

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS


Pediatr Pharm. 2018;24(7) 

In This Article

Toxicity Profile

Levetiracetam has been shown to be effective over a relatively wide range of doses, with a usual recommended dosing range of 20–60 mg/kg/day. A maximum dose has not been established, but several reports suggest that significant toxicity is rare even with doses well above the recommended range. A 2014 review of 74 children 6 years of age or younger with an accidental levetiracetam overdose found no cases of serious adverse effects.[13] A second retrospective study of 11 years of levetiracetam overdoses in children found just two cases requiring hospitalization, with only one patient having moderate adverse effects.[14]

In a 2017 issue of Clinical Neuropharmacology, Kartal described an unusual case of a 7-year-old girl with refractory seizures accidentally given high-dose levetiracetam for an extended period.[14] She had been prescribed a dose of 40 mg/kg/day, but a misunderstanding by her parent in how to give the medication resulted in her receiving 200 mg/kg/day for 55 days. Upon recognition of the error, she was immediately hospitalized for observation. Vital signs and laboratory testing remained within normal limits, and there was no evidence of any neurologic toxicity. She was observed for a period of 5 days while treatment with the correct dose was started. She remained seizure-free and without evidence of adverse effects at 1-year follow-up.