Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures

Abend, Nicholas S.; Monk, Heather M.; Licht, Daniel J.; Dlugos, Dennis J.

doi:10.1097/pcc.0b013e3181a0e1cf

Cited by 61 publications

(43 citation statements)

References 44 publications

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“…The drug has since gained broader approvals for treatment of a variety of partial and generalized seizure conditions, including those in pediatric patients 13, 14. Levetiracetam has a therapeutic profile closer to ideal than most other anticonvulsants15 and the parenteral form is now used increasingly to manage cluster seizures and status epilepticus in the very young, elderly, and critically ill humans 16, 17, 18, 19, 20…”

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confidence: 99%

Levetiracetam Rectal Administration in Healthy Dogs

Peters

Schubert

Clemmons

et al. 2014

Veterinary Internal Medicne

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BackgroundLevetiracetam is used to manage status epilepticus (SE) and cluster seizures (CS) in humans. The drug might be absorbed after rectal administration and could offer a practical adjunct to rectal administration of diazepam in managing SE and CS.HypothesisLevetiracetam is rapidly absorbed after rectal administration in dogs and maintains target serum concentrations for at least 9 hours.AnimalsSix healthy privately owned dogs between 2 and 6 years of age and weighing 10–20 kg.MethodsLevetiracetam (40 mg/kg) was administered rectally and blood samples were obtained immediately before (time zero) and at 10, 20, 40, 60, 90, 180, 360, and 540 minutes after drug administration. Dogs were observed for signs of adverse effects over a 24‐hour period after drug administration.Results C LEV at 10 minutes was 15.3 ± 5.5 μg/mL (mean, SD) with concentrations in the target range (5–40 μg/mL) for all dogs throughout the sampling period. C max (36.0 ± 10.7 μg/mL) and T max (103 ± 31 minutes) values were calculated and 2 disparate groups were appreciated. Dogs with feces in the rectum at the time of drug administration had lower mean C max values (26.7 ± 3.4 μg/mL) compared with those without (45.2 ± 4.4 μg/mL). Mild sedation was observed between 60 and 90 minutes without other adverse effects noted.Conclusions and Clinical ImportanceThis study supports the use of rectally administered levetiracetam in future studies of clinical effectiveness in the management of epileptic dogs.

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confidence: 99%

Levetiracetam Rectal Administration in Healthy Dogs

Peters

Schubert

Clemmons

et al. 2014

Veterinary Internal Medicne

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“…It is <10% protein bound, is not extensively metabolized via the cytochrome P450 pathway, and is largely eliminated unchanged by the kidneys [159]. Because of these characteristics, levetiracetam has a lower susceptibility to drug interactions compared to other antiepileptic drugs [160]. Prior studies have evaluated the PK of levetiracetam in critically ill children with epilepsy [160–164].…”

Section: Pharmacokinetic Studies In Critically Ill Childrenmentioning

confidence: 99%

Clinical Pharmacology Studies in Critically Ill Children

et al. 2016

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Developmental and physiological changes in children contribute to variation in drug disposition with age. Additionally, critically ill children suffer from various life-threatening conditions that can lead to pathophysiological alterations that further affect pharmacokinetics (PK). Some factors that can alter PK in this patient population include variability in tissue distribution caused by protein binding changes and fluid shifts, altered drug elimination due to organ dysfunction, and use of medical interventions that can affect drug disposition (e.g., extracorporeal membrane oxygenation and continuous renal replacement therapy). Performing clinical studies in critically ill children is challenging because there is large inter-subject variability in the severity and time course of organ dysfunction; some critical illnesses are rare, which can affect subject enrollment; and critically ill children usually have multiple organ failure, necessitating careful selection of a study design. As a result, drug dosing in critically ill children is often based on extrapolations from adults or non-critically ill children. Dedicated clinical studies in critically ill children are urgently needed to identify optimal dosing of drugs in this population. This review will summarize the effect of critical illness on pediatric PK, the challenges associated with performing studies in this vulnerable subpopulation, and the clinical PK studies performed to date for commonly used drugs.

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“…Recently, levetiracetam has been shown to be effective in the treatment of CSE in children [45,46]. It has been proposed that this agent has a role in management protocols for status epilepticus [47].…”

Section: Status Epilepticusmentioning

confidence: 99%

Paediatric emergencies

McDougall

2012

Anaesthesia

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SummaryThe care of sick children can be challenging for the anaesthetist who is only involved in the occasional care of paediatric patients. This paper outlines the care of medical and surgical paediatric emergencies for which an anaesthetist working at a district general hospital or equivalent may encounter. Conditions discussed include paediatric respiratory emergencies, sepsis, status epilepticus, the acute abdomen in the newborn, intussusception, the bleeding tonsil, trauma and the child with burns.

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Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures

Cited by 61 publications

References 44 publications

Levetiracetam Rectal Administration in Healthy Dogs

Levetiracetam Rectal Administration in Healthy Dogs

Clinical Pharmacology Studies in Critically Ill Children

Paediatric emergencies

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