(629) Rapid Administration of Undiluted Loading Doses of Levetiracetam

Introduction: Rapid administration of anti-seizure medications is a critical concept in the treatment of status epilepticus. Although undiluted levetiracetam doses of up to 2500 mg have been evaluated, minimal data exists to support the safety of loading doses up to 4500mg. This study will evaluate doses of levetiracetam from 2500mg to 4500 mg for safety outcomes as well as tolerability.

Methods: This is a retrospective, observational, cohort analysis of adult patients who received at least one loading dose of undiluted IV push levetiracetam from October 15, 2019, to August 31, 2020, at a large academic medical center in Phoenix, Arizona. Relevant outcomes include the safety and tolerability of rapid administration of undiluted levetiracetam at higher loading doses.

Results: We evaluated 250 doses in 250 unique patients included during the study period. Levetiracetam was a new medication for witnessed or suspected seizures in 83.6% of patients, with 32.8% having a documented history of epilepsy or seizure disorder. At the time of levetiracetam administration 49.6% of patients were on a general medicine floor, 40.4% were in the intensive care unit and 10% were in the emergency department. The median (IQR) loading dose of levetiracetam was 3500mg (3000mg-4000mg), with 3000mg being the most common loading dose given. Peripheral IV lines were utilized in 76% of patients for loading dose administration. There were no serious documented adverse events associated with IV push levetiracetam administration.

Conclusions: Rapid IV administration of undiluted doses of levetiracetam is both safe and tolerable in loading doses of 2500 mg to 4500 mg, allowing for rapid drug administration in the setting of status epilepticus.