Comparison of Levetiracetam Dosing Regimens in End-Stage Renal Disease Patients Undergoing Intermittent Hemodialysis

Abstract

Compared to LEV daily, BID dosing achieved significantly higher levels and a better recovery to predialysis levels. Although limited by small numbers, a similar relationship between postdialysis levels was not detected.

Atypical, Levetiracetam-induced Hypersensitivity Syndrome Complicated by Fulminant Liver Failure in a Patient Undergoing Hemodialysis

“…Regarding LEV pharmacokinetics among patients undergoing intermittent hemodialysis, the volume distribution of LEV and the intradialytic elimination half-life are reported to be 0.48 L/kg and 31 h, respectively. HD removes nearly 85% of serum LEV ( 23 ), and the potential risk of underdosing of LEV in HD patients has been reported ( 24 , 25 ). We suspect that the accumulation of LEV itself did not contribute to the development of DIHS/DRESS in our case.…”

Drug Interaction Between Sevelamer and Levetiracetam: The First Clinical Experience

“…His levetiracetam dose adjustment on dialysis days was not indicated as he had already been on twice daily regimen and remained seizure free on same dosage for over 3 years. 8 Although some drug labels caution users about the potential interaction of levetiracetam with sertraline, this patient experienced no adverse reactions and continued his medication regimen unperturbed. It was only on sevelamer administration that the patient experienced episodes of recurrent seizures, pointing to a previously unbeknownst sevelamer–levetiracetam interaction.…”

“…2 Similar to the magnitude of lipid solubilitydependent sequestration of local anesthetics previously reported, that of highly lipid soluble nonlocal anesthetic drugs (Table 1) such as bupropion, verapamil, quetiapine, and amitriptyline by lipid emulsion is mainly dependent on the partition coefficient (lipid solubility constant). 2,7,8 Lipid emulsion produces positive inotropic effects and increases left ventricular systolic pressure through inhibition of nitric oxide release. 2,9 Considering these previous reports, reversal of the cardiac toxicity (QRS widening and prolongation of PR and QT intervals) and central nervous system abnormalities (seizure and coma), management of hypotension, and reduction of the dosage of vasopressors and inotropics (norepinephrine, epinephrine, and dopamine) required for hemodynamic support were observed (Table 1), perhaps due to lipid shuttle and inotropic effects.…”

“…2,9 Considering these previous reports, reversal of the cardiac toxicity (QRS widening and prolongation of PR and QT intervals) and central nervous system abnormalities (seizure and coma), management of hypotension, and reduction of the dosage of vasopressors and inotropics (norepinephrine, epinephrine, and dopamine) required for hemodynamic support were observed (Table 1), perhaps due to lipid shuttle and inotropic effects. 2,3,[6][7][8][9] The recommended dosage of lipid emulsion in local anesthetic systemic toxicity in adults is as follows: bolus administration of lipid emulsion (20%) 1.5 mL/kg, followed by continuous infusion of lipid emulsion (20%) 0.25…”

Treatment with lacosamide or levetiracetam in patients with renal replacement therapy. What is really known?

“…Additionally, a case series of 14 patients receiving doses ranging from 250 mg to 1000 mg LEV twice/day and 8 patients receiving 500 mg to 1500 mg daily with a supplementary dose after haemodialysis was published (Shive et al, 2017). LEV twice/day resulted in higher peak and trough concentrations than LEV daily.…”