Safety and Tolerability of Rapid Administration Undiluted Levetiracetam

Morgan, Olivia; Medenwald, Brittny

doi:10.1007/s12028-019-00708-5

Cited by 28 publications

(45 citation statements)

References 6 publications

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“…There are 3 prior studies that discuss the rapid IV infusion of LEV. [4][5][6] The first is a retrospective study published in March 2019 that looked at doses of IV LEV ranging from 500 mg to 1000 mg finding that this was safe and well tolerated. Out of the 199 patients and 1626 doses, there were no patients with adverse events, though the only events measured were IV site related.…”

Section: Discussionmentioning

confidence: 99%

“…3 With the acidic formulation, the necessary dilution and slow infusion rate leads to potential delays in patient care which is not ideal when treating acute seizure and status epilepticus. A previous study has shown safety when rapidly infusing undiluted LEV at doses < 1000 mg. 4 In addition, very recent studies showed that high doses of LEV could be rapidly infused safely with minimal dilution in doses ranging from 1000 mg to 4500 mg. 5,6 Given the paucity of literature on this topic outside of these studies, this retrospective study aims to further the standard of care regarding the safety and efficacy of rapid administration of LEV in the setting of status epilepticus and to evaluate potential side effects beyond local site reaction.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Safety of Rapid Administration of Undiluted High-Dose Intravenous Levetiracetam

Kasturiarachi

Krishnan

Alsbrook

et al. 2022

The Neurohospitalist

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Background Intravenous (IV) levetiracetam (LEV) is an antiseizure medication traditionally given as an intermittent infusion to mitigate potential adverse effects given its acidic formulation. The process of compounding may lead to delays in treating status epilepticus, which is why administration of undiluted doses is of interest. Prior studies have shown safety of IV doses from 1000 mg to 4500 mg; however, assessments of adverse side effects outside IV site reactions have not been studied. Methods A retrospective analysis was completed with patients who received 1500 mg doses of undiluted IV LEV. We included patients ≥ 18 years old that received at least 1 dose of IV LEV 1500 mg from January 2018 to February 2021. Study end points included assessment of hemodynamic disturbance (bradycardia [HR less than 50 beats per minute] or hypotension [SBP less than 90 mmHg] within 1 hour or documented infusion reaction within 12 hours of LEV. Descriptive statistics were utilized. Results A total 213 doses of 1500 mg of IV LEV were administered to 107 patients. Peripheral lines were used for 85.9% of doses. Approximately half of doses (57) were administered to patients on the general wards, with the remainder in the intensive care unit or emergency department. Two patients (1.9%) experienced bradycardia; however, 1 patient had pre-existing bradycardia. Three patients (3.8%) experienced hypotension; however, those patients were receiving vasopressors prior to the dose. There were no cases of infusion reaction. Conclusion Undiluted, rapid administration of IV LEV 1500 mg was well tolerated and safe.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Safety of Rapid Administration of Undiluted High-Dose Intravenous Levetiracetam

Kasturiarachi

Krishnan

Alsbrook

et al. 2022

The Neurohospitalist

View full text Add to dashboard Cite

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“…Minimal dilution requires bedside admixture in a 1:1 manner, which has the potential to lead to confusion and difficulty administering both higher doses and larger volumes without a syringe pump. Given those additional concerns, some institutions have implemented a strategy of rapid administration of undiluted LEV at doses of 1000 mg or less 5 …”

Section: Discussionmentioning

confidence: 99%

“…Minimally diluted LEV has been reported to be well tolerated, with minimal side effects, allowing for more rapid administration compared to packaged labeling 5,7 …”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, LEV is admixed with at least 100 ml of 5% dextrose or sodium chloride 0.9% and administered over 15–60 min 4 . Recent studies have shown that undiluted LEV may be administered rapidly at doses of up to 1000 mg 5 . Additionally, the ECLIPSE trial administered doses of up to 2500 mg over 5 min, diluted in 100 ml of solution 6 …”

Section: Introductionmentioning

confidence: 99%

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Rapid administration of undiluted intravenous levetiracetam

2021

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Objective Operational delays have the potential to lead to suboptimal time to seizure control during status epilepticus. Levetiracetam (LEV) is an urgent control antiepileptic medication that offers relative lack of adverse effects and ease of monitoring. There are limited data published demonstrating safety and tolerability of undiluted rapid intravenous (IV) push of LEV in doses of 1000 mg or less. The purpose of this study was to evaluate the safety of IV push administration of LEV doses up to 4500 mg. Methods This is a retrospective, observational, cohort analysis of adult patients who received at least one dose of undiluted IV push LEV from October 15, 2019 to August 31, 2020 at a large academic medical center in Phoenix, Arizona. Outcomes of interest include safety and tolerability of rapid administration of undiluted LEV. Results There were 953 unique patients included during the study period. LEV was a new medication for witnessed or suspected seizure in 51.9% of patients, and 40.7% of patients had a documented history of epilepsy or seizure disorder. There were 8561 undiluted IV push LEV doses administered, 3674 (42.9%) of which were greater than 1000 mg. LEV was administered most often through a peripheral IV (79.1%). There were 12 patients with documented adverse drug events during the study period, with four potentially directly related to IV push LEV administration. These events were limited to local injection site reactions and included redness, burning, and loss of a peripheral IV line. Significance Rapid IV administration of undiluted LEV is both safe and tolerable in doses of up to 4500 mg, allowing for rapid drug administration, which is paramount during neurologic emergencies.

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Creation and execution of an effective critical care pharmacist collaborative in an academic health system

Derry,

Duby,

Firestone

et al. 2023

J Am Coll Clin Pharm

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Hospital systems continue to face significant pressure to mitigate medication costs, which may be achieved by effective pharmacy collaboration between medical centers. The purpose of this narrative is to discuss the essential elements, methods, obstacles, and solutions that were encountered in the formation and function of a successful multicenter pharmacy collaborative. The objective is to share the tools and examples that illustrate the framework and mechanics employed by a collaborative to execute initiatives that improved patient care and institutional processes. In 2018, five academic medical centers (AMCs) formed a critical care pharmacy collaborative team (PCT). The group's sustainable leadership structure allowed for equal voicing while avoiding individual burnout. Focused monthly working meetings allowed for comparison of each AMC's best practices to identify unexplored practice gaps and project planning. System goals with standardized metrics were set and parallel institutional approaches were implemented. Pooling use experience from five AMCs allowed for a larger sample size for data evaluation to assist in management of high impact medications. Additional benefits of group collaboration extended to research opportunities and incorporation of pharmacy learners for practice‐based learning. During this journey, barriers were uncovered including inconsistent access to a centralized secure platform for information sharing, data collection and analysis, overreliance of responsibilities on few individuals, and unpredictable dedicated project time for team leads and members. Overall, pharmacist led stewardship projects across five AMCs were leveraged to advance patient care through increased clinical guideline adherence, operational efficiency, and medication cost savings.

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Safety and Tolerability of Rapid Administration Undiluted Levetiracetam

Cited by 28 publications

References 6 publications

Evaluation of the Safety of Rapid Administration of Undiluted High-Dose Intravenous Levetiracetam

Evaluation of the Safety of Rapid Administration of Undiluted High-Dose Intravenous Levetiracetam

Rapid administration of undiluted intravenous levetiracetam

Creation and execution of an effective critical care pharmacist collaborative in an academic health system

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