Safety of Intravenous Push Lacosamide Compared With Intravenous Piggyback at a Tertiary Academic Medical Center

Abstract

Background: There are limited data regarding the incidence of adverse events associated with administering lacosamide by intravenous push (IVP) compared with IV piggyback (IVPB). Objective: The objective of this analysis was to compare the safety profile, including cardiovascular effects, sedative effects, and IV site reactions of IVP and IVPB lacosamide administration. Methods: A retrospective pre/post cohort analysis comparing patients who received lacosamide via IVP and IVPB was conducted. Safety end points included hypotension, bradycardia, medication-related sedation, and IV site reactions. The relationship between patient characteristics and the incidence of safety end points was analyzed using the Student t-test and χ2 test as appropriate. Results: Bradycardia occurred after 0.19% of IVP administrations and 1.09% of IVPB administrations assessed ( P = 0.07). Hypotension was observed in 3.16% of IVP administrations compared to 1.59% in the IVPB cohort ( P = 0.12). Post lacosamide-related sedation was noted in 11.32% and 11.68% of the IVP and IVPB cohorts, respectively ( P = 0.87). Infusion site reaction rates of 1.80% and 0.84% were documented in the IVP and IVPB cohorts, respectively ( P = 0.33). Of note, only 1 adverse event required clinical intervention. One 200-mg dose in the IVP cohort required a fluid bolus postadministration. Conclusion and Relevance: IVP lacosamide was associated with a similar incidence of cardiovascular, neurological, and infusion site–related adverse events compared with IVPB, in which nearly every adverse event was deemed clinically insignificant. Lacosamide administered via IVP may be considered a safe alternative method of administration in the acute care setting.

Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

“…Hypotension was defined as a systolic blood pressure (SBP) <90 mm Hg or a reduction of ≥30% from baseline blood pressure. 13 Bradycardia was defined as a heart rate (HR) <50 beats per minute (BPM) or a reduction of ≥30% from baseline HR. 13 For hypotensive and bradycardic events, the SBP and HR values used were defined as the closest measured value within 6 hours prior to and following olanzapine administration.…”

“…13 Bradycardia was defined as a heart rate (HR) <50 beats per minute (BPM) or a reduction of ≥30% from baseline HR. 13 For hypotensive and bradycardic events, the SBP and HR values used were defined as the closest measured value within 6 hours prior to and following olanzapine administration. Baseline SBP and HR values less than 90 mm Hg or 50 BPM, respectively, were not included for assessment of hypotension or bradycardia after the respective administration of olanzapine.…”

“…To assess the clinical relevance of both the hypotension and bradycardia end points, each end point was assessed as either “requiring intervention” or “not requiring intervention.” Hypotensive events were recorded as requiring intervention if the patient received 1 or more of the following within 2 hours following a dose of olanzapine: a fluid bolus, the initiation of a vasopressor or inotropic agent, an escalation in dose of a previously initiated vasopressor or inotropic agent, a reduction in dose of any antihypertensive agents, diuretics, or afterload reducing agents, or had any of the aforementioned agents discontinued as a result of hypotension. 13 Any agent requiring discontinuation or dose reduction was classified as a continuous infusion, scheduled oral, or IVP medication. Bradycardic events were recorded as requiring intervention if the patient received 1 or more of the following within 2 hours following a dose of olanzapine: the administration of a fluid bolus, the initiation of a vasopressor or inotropic agent, or the administration of glycopyrrolate or atropine.…”

“…Bradycardic events were recorded as requiring intervention if the patient received 1 or more of the following within 2 hours following a dose of olanzapine: the administration of a fluid bolus, the initiation of a vasopressor or inotropic agent, or the administration of glycopyrrolate or atropine. 13 The interventions used for hypotensive and bradycardic events were at the discretion of the treating provider.…”

Evaluation of Cardiovascular Concerns of Intravenous Lacosamide Therapy in Epilepsy Patients

“…This was known for another old SCB-ASM, phenytoin ( 16 ). There were limited data on the cardiac safety of intravenous LCM ( 6 , 17 , 18 ). A Korean study that focused on the cardiac safety of rapid intravenous LCM suggested a relatively higher rate (32.9%) of cardiac adverse event, especially the new-onset first-degree atrioventricular block (22.4%) ( 6 ).…”