The safety of rapid infusion levetiracetam: A systematic review

Jense, Alexa; Douville, Alyssa A; Weiss, Ashley

doi:10.1002/phar.2687

Cited by 11 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another retrospective review of 33 adult patients in the ICU showed that there was no difference in side effects in the 16 patients who received an undiluted bolus over 3–5 min and the 17 patients who received an infusion at a rate of 200–400 mg/hr (Burakgazi, Bashir, Doss, & Pellock, 2014). A recent systematic review of nine articles investigated rapid levetiracetam administration over 5 min, with doses ranging from 280 to 4,500 mg (Jense, Douville, & Weiss, 2022). The authors concluded that the administration of intravenous levetiracetam at a fast rate appears to be safe and tolerable via a peripheral line with few adverse effects, suggesting that SE treatment may be safely expedited by administering it more rapidly than other agents.…”

Section: Antiepilpetic Drugsmentioning

confidence: 99%

Optimizing Status Epilepticus Management in the Emergency Department

Weant

Gregory

2023

Advanced Emergency Nursing Journal

View full text Add to dashboard Cite

Status epilepticus (SE) is a frequent medical emergency that requires expedited treatment to avoid the ensuing high incidence of morbidity and mortality associated with prolonged seizures. Protracted seizure duration itself has the potential to result in maladaptive neuronal responses that can not only further increase seizure duration and worsen clinical outcomes but also lead to reduced responsiveness to pharmacotherapy. Benzodiazepines are consistently recommended as first-line treatment due to their rapid onset and efficacy in terminating seizures, followed by the emergent administration of an antiepileptic drug (AED). Various benzodiazepine and AED options are recommended and can be utilized in this setting, all with their own unique advantages and challenges. With time at a premium, agents should be selected that can be rapidly administered and have an advantageous pharmacokinetic profile in order to limit seizure duration and optimize outcomes. The intent of this review is to provide an outline of the importance of time-to-treatment implementation in this setting, assess the landscape of options that may provide timing advantages, and examine potential strategies for deploying expeditious therapy.

show abstract

Section: Antiepilpetic Drugsmentioning

confidence: 99%

Optimizing Status Epilepticus Management in the Emergency Department

Weant

Gregory

2023

Advanced Emergency Nursing Journal

View full text Add to dashboard Cite

show abstract

“…4 Although there is limited evidence supporting faster infusion times in pediatric patients, many institutions report infusing the drug at a faster rate than the recommended 15-min infusion, based on use in several prospective randomized trials. 3,5,[6][7][8] Literature evaluating undiluted levetiracetam administration is limited to date, especially in the pediatric population. Three retrospective studies published over the last 2 years in adults have evaluated the use of rapid undiluted levetiracetam in doses ranging from 500 to 4500 mg.…”

Section: Introductionmentioning

confidence: 99%

“…According to the manufacturer package labeling, levetiracetam vials for intravenous preparation must be diluted prior to use and infused over 15 min 4 . Although there is limited evidence supporting faster infusion times in pediatric patients, many institutions report infusing the drug at a faster rate than the recommended 15‐min infusion, based on use in several prospective randomized trials 3,5,6–8 . Literature evaluating undiluted levetiracetam administration is limited to date, especially in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the safety and tolerability of intravenous undiluted levetiracetam at a pediatric institution

Price,

Garrity,

Stiehl

2023

Pharmacotherapy

View full text Add to dashboard Cite

Study ObjectiveRecent studies suggest rapid administration of high‐dose, undiluted levetiracetam is safe in adults; however, no information exists in pediatric patients. The purpose of this study was to evaluate the safety and tolerability of undiluted levetiracetam at a pediatric institution.DesignRetrospective, single‐center, cohort study.SettingPediatric Academic Medical Center.PatientsAll patients who received high‐dose >60 mg/kg (‒10%) up to 4500 mg undiluted or diluted intravenous levetiracetam were included.InterventionRapid intravenous administration of undiluted versus diluted levetiracetam.Measurements and Main ResultsA total of 776 levetiracetam doses were included, 358 doses administered and 418 doses wasted. The doses administered (61 undiluted and 297 diluted) accounted for a total of 252 patients (39 received undiluted, and 213 received diluted levetiracetam) (median [minimum–maximum range] age, 2 years [1 day to 32.7 years]; mean (standard deviation [SD]) weight, 20.1 kg [22.1 kg]). The incidence of hemodynamic disturbances and infusion‐related reactions was not statistically significant between undiluted (24.6%) and diluted (26.3%) groups (p = 0.87). The median (interquartile range [IQR]) time difference between first‐line antiseizure medication and levetiracetam administration in patients with status epilepticus was 18 min (10.5–30.5) in the undiluted group versus 36.5 min (21.8–67.3) in the diluted group (p < 0.01). Additionally, there was a significant amount of drug waste from dispensed but not administered doses of the diluted bag compared to undiluted vials (57.6% diluted vs. 18.7% undiluted, p < 0.001).ConclusionUndiluted levetiracetam was not associated with an increased incidence of adverse effects compared to diluted levetiracetam in high‐doses, up to 4500 mg given over 5 min in pediatric patients.

show abstract

“…9,10 Levetiracetam is safe with the most common adverse effects being mild. 11-15 In a recent study of 199 adult patients who received 1626 total doses of undiluted IV LEV (maximum 1000 mg), only 1.5% experienced agitation, delirium, confusion, and/or lethargy. 10 This study called for further assessment of safety for undiluted administration with regard to higher doses of LEV.…”

Section: Introductionmentioning

confidence: 99%

An Emergency Department Quality Improvement Project for Intravenous Levetiracetam Administration

Rublee

Hynes

Paavola

et al. 2022

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Background: Levetiracetam is a readily available, safe anticonvulsive medication. It is frequently administered as IV piggyback with a pump, carrier fluid, and tubing. The Established Status Epilepticus Treatment Trial demonstrated levetiracetam being similarly effective to previously used treatments in doses up to 4500 mg administered over 10 minutes. Objective: We sought to compare usage, cost, and waste of IV piggyback with IV push administration of levetiractam following implementation of an IV push protocol in an academic emergency department. Methods: A three-month review of levetiracetam administration was done following protocol implementation using IV push for initial treatment of benzodiazepine-refractory status epilepticus. The review quantified the number of IV push vs IV piggyback doses for all indications and evaluated cost of supplies necessary for administration. Results: During the study period, 137 patients received 142 doses of IV levetiracetam. Fifty-one doses (36%) were given as IV push rather than IV piggyback. The majority of doses 116 (82%) were 1000-2000 mg and 11 doses (8%) 3500-4500 mg. Estimated three-month savings with complete transition of IV piggyback to IV push would exceed $6000 just in our ED. The amount of sterile solution carrier fluid was also reduced and IV pump time freed. Conclusion: Implementation of an emergency department IV push levetiracetam protocol resulted in cost savings. Opportunities remain to improve clinical implementation practices. Medication administration represents one crucial target area where healthcare systems can implement policies to reduce waste and commit to climate-smart health care.

show abstract

The safety of rapid infusion levetiracetam: A systematic review

Cited by 11 publications

References 16 publications

Optimizing Status Epilepticus Management in the Emergency Department

Optimizing Status Epilepticus Management in the Emergency Department

Evaluation of the safety and tolerability of intravenous undiluted levetiracetam at a pediatric institution

An Emergency Department Quality Improvement Project for Intravenous Levetiracetam Administration

Contact Info

Product

Resources

About