Abstract
Introduction
In intensive care unit (ICU) patients, seizure or status epilepticus treatment with intravenous benzodiazepines or conventional antiepileptic drugs (AEDs), such as phenytoin, may be accompanied by cardiovascular depression or hypotension. Levetiracetam (LVM) is a novel AED that does not undergo extensive liver metabolism, does not require drug level monitoring, and is not associated with hemodynamic instability. We retrospectively analyzed the use, safety, and efficacy of LVM in ICU patients.
Methods
Collected data included age, sex, therapy indication and duration, dosing regimen, documented seizure activity, ICU admission diagnoses, length of ICU stay, serum creatinine, liver function tests, adverse reactions, concomitant use of other AEDs, and drug interactions.
Results
Fifty-one patients were identified (26 males; mean (SD) age, 58.2 (19.8) years). Most patients (65%) did not receive a loading dose; the most common loading dose was 1,500 mg (50% of 18 patients). The most common maintenance dose was 500 mg twice daily (59% of 51 patients), and average duration of therapy was 13.6 (12.7) days. Approximately 47% of patients had preexisting liver disease, and 25% had elevated serum creatinine. Twenty-two patients received LVM therapy for seizure prophylaxis; 29 for acute seizure treatment. Ninety-three percent of patients treated with LVM for acute seizure had no subsequent seizures; the remaining patients (7%) required additional AEDs. One patient receiving LVM for seizure prophylaxis had documented seizures requiring additional AEDs. No adverse hemodynamic events or cardiac arrhythmias were reported.
Conclusion
LVM appears to be safe for ICU patients when dosing is adjusted for renal function.
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Abbreviations
- AED:
-
Antiepileptic drug
- ICU:
-
Intensive care unit
- IV:
-
Intravenous
- LVM:
-
Levetiracetam
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Acknowledgments
Dr. Freeman acknowledges research funding provided in part by the Robert H. and Clarice Smith/M.L. Simpson Foundation Trust.
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Nau, K.M., Divertie, G.D., Valentino, A.K. et al. Safety and Efficacy of Levetiracetam for Critically Ill Patients with Seizures. Neurocrit Care 11, 34–37 (2009). https://doi.org/10.1007/s12028-009-9185-0
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DOI: https://doi.org/10.1007/s12028-009-9185-0