Repeated Use of Subcutaneous Levetiracetam in a Palliative Care Patient

López-Saca, José Mario; Vaquero, J.; Larumbe, Ana; Urdíroz, Juli; Centeno, Carlos

doi:10.1016/j.jpainsymman.2013.01.006

Cited by 33 publications

(15 citation statements)

References 3 publications

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“…10 Additionally, adequate serum levels after SC administration could be reported. In contrast, we used highly concentrated levetiracetam to ensure absorption from the subcutaneous tissue.…”

Section: Journal Of Pain and Palliative Care Pharmacotherapymentioning

confidence: 97%

“…9 Furthermore, López-Saca et al recently reported the successful use of intermittent levetiracetam SC in a 70-year-old palliative care patient. 10 The subcutaneous application of drugs and fluids is commonly used in palliative care if patients are unable to swallow and other routes of administration are not applicable, are unacceptable, or are not feasible in the specific setting (e.g., care at home). 11,12 It allows administering drugs irrespective of intravenous access, e.g., at sites such as the abdominal wall, thighs, or the scapula area of the back.…”

Section: Introductionmentioning

confidence: 99%

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Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Rémi¹,

Lorenzl²,

Vyhnalek³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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To evaluate the tolerability and clinical effects of subcutaneous (SC) levetiracetam for the treatment of epileptic seizures in a palliative care setting, we conducted a retrospective chart review of patients treated with subcutaneous levetiracetam in the Department of Palliative Medicine at the University Munich, between September 2006 and March 2013. The following parameters were extracted from the charts: reason for antiepileptic drug treatment, daily dose, concentration, infusion rate, co-administration of other drugs, and clinical effects. Furthermore, the charts were screened for signs of adverse drug reactions, e.g., irritation or pain at the infusion site. We identified 20 patients that were treated with levetiracetam SC in the inpatient (n = 7) and outpatient (n = 13) settings. Most patients (n = 17) tolerated the subcutaneous infusion well. Nineteen patients (95%) received levetiracetam in combination with other drugs. These were mainly metamizol (80%), midazolam (75%), and morphine (45%). The median dose of levetiracetam was 95.8 mg/h (SD 37 mg/h), median osmolarity of the infusion solution 2203 mOsmol/L (SD 717 mOsmol/L), and infusion rate 2 mL/h (SD 2.4 ml/h). In 16 patients (80%), seizures were controlled and status epilepticus were interrupted, respectively. We conclude that SC levetiracetam is an effective treatment and well tolerated in the palliative care setting.

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“…10 Additionally, adequate serum levels after SC administration could be reported. In contrast, we used highly concentrated levetiracetam to ensure absorption from the subcutaneous tissue.…”

Section: Journal Of Pain and Palliative Care Pharmacotherapymentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Rémi¹,

Lorenzl²,

Vyhnalek³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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“…Seizures are frequently a cause for family and patient distress and are detrimental to the patient’s quality of life 3. Intravenous drug administration is particularly difficult in a palliative home care setting, making seizure control challenging in clinical practice 4.…”

Section: Discussionmentioning

confidence: 99%

Continuous subcutaneous levetiracetam in end-of-life care

Furtado¹,

Gonçalves

et al. 2018

BMJ Case Reports

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Seizures constitute a determining aspect in quality of life and are frequently challenging in palliative care—a field where treatment has yet to be standardised. Levetiracetam—a new generation anticonvulsant—has proved efficacy both through oral, as well as intravenous administration in the general population. This case reports on the use of continuous subcutaneous levetiracetam to effectively control seizures in a terminally ill patient without patent oral route.

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“…Literature reports the successful use of levetiracetam in subcutaneous infusions in adults requiring palliative care 20,21 , and this option may be a useful adjunct for consideration in similar cases in the future.…”

Section: Discussionmentioning

confidence: 99%

Seizure management in children requiring palliative care: a review of current practice

Harris

Baba²,

Mellor

et al. 2017

BMJ Support Palliat Care

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ObjectivesControlling seizures in children approaching death can be difficult, and there is a limited evidence base to guide best practice. We compared current practice against the guidance for seizure management produced by the Association of Paediatric Palliative Medicine (APPM).MethodsRetrospective case note review of episodes of challenging seizure management in children receiving end-of-life care over a 10-year period (2006–2015) in the south-west region of England.ResultsWe reviewed 19 admissions, in 18 individuals. Six (33%) had a malignancy, nine (50%) had a progressive neurodegenerative condition and three (17%) had a static neurological condition with associated epilepsy. Thirteen (72%) died in their local hospice, four (22%) at home, and one (6%) in hospital. Seventeen of 19 episodes involved the use of subcutaneous or intravenous midazolam infusion, for a mean of 11 days (range 3–27). There was a wide range of starting doses of midazolam, and 9/17 (53%) received final doses in excess of current dose recommendations. Six individuals received subcutaneous phenobarbital infusions, with four of these (67%) receiving final doses in excess of current dose recommendations. Plans for adjustments of infusion rates, maximal doses or alternative approaches should treatment fail were inconsistent or absent. In 16/18 (88%) cases seizures were successfully controlled prior to the day of the child’s death. Staff found the experience of managing seizures at end of life challenging and stressful.ConclusionsPharmacological approaches to seizure management in end-of-life care are variable, often exceeding APPM dose recommendations. Despite this, safe and effective seizure control was possible in all settings.

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Repeated Use of Subcutaneous Levetiracetam in a Palliative Care Patient

Cited by 33 publications

References 3 publications

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Continuous subcutaneous levetiracetam in end-of-life care

Seizure management in children requiring palliative care: a review of current practice

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