Levetiracetam-Rex®, Keppra®

Reviewed by Kiri Aikman, Brenda Hughes, Elizabeth Oliphant, Cynthia Sharpe & Malcolm Battin
Feb 2015
Administration Newborn Drug Protocol Index Newborn Services Home Page


Dose and Administration


Neonatal seizures unresponsive to first-line agents


PLEASE NOTE: There are TWO strenghts of Levetiracetam injection:

The use of levetiracetam in neonates is unlicensed. Limited data are available1-7
Consult a paediatric neurologist for prescribing advice BEFORE prescribing levetiracetam

This guideline covers in neonates 36 weeks gestation and over.

Loading Dose

Maintenance Dose

  Postnatal Age Dose Dosing Interval
Intraveous / Oral
< 7 days 10mg/kg q 8h
>7 days 20mg/kg q 12h


Neonatal seizures unresponsive to first-line agents


Hypersensitivity to levetriacetam or any component of the formulation

Clinical Pharmacology

Levetiracetam is an antiepileptic drug used in the treatment of refractory neonatal seizures. The precise mechanism by which levetiracetam exerts its antiepileptic effect is unknown. However, several studies have suggested the mechanism may involve one or more of the following central pharmacologic effects: inhibition of voltage-dependent N-type calcium channels; facilitation of GABA-ergic inhibitory transmission through displacement of negative modulators; reduction of delayed rectifier potassium current; and/or binding to synaptic proteins which modulate neurotransmitter release3,4.

Intravenous administration leads to peak serum levels 1 hour earlier than oral administration and therefore intravenous administration is the preferred route for the treatment of acute seizures and in neonates who are nil by mouth.

Possible Adverse Effects

Special Considerations