Levetiracetam Pharmacokinetics During Continuous Venovenous Hemofiltration and Acute Liver Dysfunction

Andrea M. New, Scott D. Nei, Kianoush B. Kashani, Alejandro Rabinstein, Erin N. Frazee

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Levetiracetam clearance is dependent on renal (major) and hepatic (minor) elimination pathways. In the setting of organ dysfunction, dose reductions are recommended to prevent accumulation. Continuous venovenous hemofiltration (CVVH) has been shown to eliminate levetiracetam, but the preferred dosing regimen when a patient is on CVVH and has concomitant acute liver dysfunction is unknown. The objective of this case is to describe levetiracetam dosing and pharmacokinetics in the setting of CVVH and acute liver dysfunction. Methods: This is a case report of a single patient. Results: A 59-year-old male was admitted to the intensive care unit for acute onset multiorgan dysfunction associated with a hematologic disorder. His hospital course was complicated by persistent liver dysfunction with a model for end-stage liver disease score of 47 and renal failure which necessitated initiation of CVVH. On hospital day two, the patient developed new-onset focal seizures secondary to metabolic abnormalities that resulted in the initiation of levetiracetam 1000 mg intravenously twice daily. The peak concentration at steady state was 32.2 mcg/mL, and the trough concentration was 16.1 mcg/mL (goal 12–46 mcg/mL). The volume of distribution was 0.65 L/kg, and the elimination half-life was 11.4 h. Conclusion: Levetiracetam pharmacokinetics observed in this case approximated those seen in a normal healthy patient and a regimen of 1000 mg twice daily achieved serum trough concentrations at the lower limit of the target range. This case indicates that in a patient with acute liver dysfunction on CVVH, 1000 mg twice daily may be considered as an empiric levetiracetam regimen.

Original languageEnglish (US)
Pages (from-to)141-144
Number of pages4
JournalNeurocritical Care
Volume25
Issue number1
DOIs
StatePublished - Aug 1 2016

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etiracetam
Hemofiltration
Liver Diseases
Pharmacokinetics
End Stage Liver Disease
Renal Insufficiency
Intensive Care Units
Half-Life
Seizures

Keywords

  • Antiepileptic drugs
  • Dialysis
  • Epilepsy
  • Neurology
  • Pharmacokinetics
  • Renal

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Levetiracetam Pharmacokinetics During Continuous Venovenous Hemofiltration and Acute Liver Dysfunction. / New, Andrea M.; Nei, Scott D.; Kashani, Kianoush B.; Rabinstein, Alejandro; Frazee, Erin N.

In: Neurocritical Care, Vol. 25, No. 1, 01.08.2016, p. 141-144.

Research output: Contribution to journalArticle

New, Andrea M. ; Nei, Scott D. ; Kashani, Kianoush B. ; Rabinstein, Alejandro ; Frazee, Erin N. / Levetiracetam Pharmacokinetics During Continuous Venovenous Hemofiltration and Acute Liver Dysfunction. In: Neurocritical Care. 2016 ; Vol. 25, No. 1. pp. 141-144.
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