(1211) Evaluation of a Weight-Based Levetiracetam Loading Dose Protocol

Introduction: Status epilepticus (SE) is a common neurological emergency in both emergency departments and intensive care units. The goal of SE management is to rapidly terminate both clinical and electrographic seizure activity. Levetiracetam (LEV) is a favorable second line agent in SE because it can be administered rapidly as an undiluted IV push, has minimal drug interactions, and has a favorable adverse effect profile. Recommended loading doses for LEV in SE range from 40 – 60 mg/kg, with a maximum dose of 4500 mg. In April 2020, weight based order sentences were implemented to reflect appropriate weight based loading doses of LEV. This study aims to evaluate the effectiveness of implementing a weight based LEV loading dose order sentence for patients in SE.

Methods: This was a retrospective, single center before-after study of patients that received a loading dose of LEV greater than 2500 mg from October 1, 2019 to October 19, 2021. Patients were excluded if they received a LEV dose less than 2.5 g or were pregnant. The primary objective was to evaluate the effectiveness of weight based LEV loading dose order sentences for patients with SE.

Results: A total of 362 loading doses were evaluated with 17 LEV doses prior to order sentence implementation and 345 LEV doses after implementation. In the pre implementation group, 41% of loading doses were within the goal dose range (n=17) though the average dose was 35.8 mg/kg. In the post implementation group, 58.8% of orders were within goal range (n=345) with an average loading dose of 47.1 mg/kg. Doses that exceeded 60 mg/kg accounted for 12.1% of all orders.

Conclusions: Implementation of a weight based loading dose order sentence resulted in more patients receiving guideline recommended LEV loading doses for patients in SE.