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Safety and Tolerability of Rapid Administration Undiluted Levetiracetam

Abstract

Background/Objective

Levetiracetam (LEV) is an antiepileptic drug used widely in patients with a favorable safety profile. Studies evaluating the safety and efficacy of intravenous (IV) LEV included volumes of at least 100 mL. Minimally diluted doses administered over 5–6 min were found to be both safe and effective. Given the complexities of admixing, this practice can be impractical and result in delays in antiepileptic therapy. This study aimed to retrospectively review the safety and tolerability of rapid administration of undiluted LEV doses ≤ 1000 mg.

Methods

This was a retrospective study evaluating adverse drug reactions associated with undiluted LEV from January 1, 2018–June 1, 2018. Patients were included if they received at least one dose of undiluted LEV and were ≥ 18 years old. Safety endpoints were reviewed and collected from the time administration until hospital discharge. Endpoints included injection site pain and discomfort, injection site erythema, extravasation, IV line replacement, and any documented adverse effect leading to IV LEV discontinuation. Descriptive statistics were used to analyze the data.

Results

A total of 199 patients were included in the study totaling 1626 doses of LEV. Most patients were administered LEV 1000 mg (60.8%), through a peripheral line (64.3%), and were prescribed LEV for seizure prophylaxis (58.3%). Patients received a mean of 8.1 ± 8 doses for a mean duration of therapy of 5 ± 4.5 days. About 98.5% of patients did not experience an adverse effect, whereas 1.5% of patients experienced agitation, delirium, confusion, and/or lethargy, which is well known to LEV therapy.

Conclusions

Rapid administration of undiluted LEV doses ≤ 1000 mg were well tolerated with no concentration-related side effects. Further prospective research is needed to confirm this observation as well as the safety of higher doses.

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Author information

OJM—Established study design, secured IRB approval, Data collection, interpretation of data, development of final manuscript. BM—Data collection, interpretation of data, development of final manuscript.

Correspondence to Olivia Morgan.

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Source of Support

There is no financial support or sources of support to disclose.

Conflicts of Interest

All authors declare that they have no conflict of interest to disclose.

Ethical Approval/Informed Consent

All data were extracted from the electronic medical record, and the study was approved by the Emory University Institutional Review Board.

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Morgan, O., Medenwald, B. Safety and Tolerability of Rapid Administration Undiluted Levetiracetam. Neurocrit Care 32, 131–134 (2020). https://doi.org/10.1007/s12028-019-00708-5

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Keywords

  • Anticonvulsants
  • Humans
  • Intravenous