Safety and efficacy of levetiracetam for critically Ill patients with seizures

Karen M. Nau, Gavin D. Divertie, Alden K. Valentino, William D. Freeman

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)34-37
Number of pages4
JournalNeurocritical Care
Volume11
Issue number1
DOIs
StatePublished - Aug 2009

Fingerprint

etiracetam
Critical Illness
Seizures
Safety
Anticonvulsants
Intensive Care Units
Creatinine
Hemodynamics

Keywords

  • Antiepileptic drugs
  • Intensive care units
  • Levetiracetam
  • Seizures
  • Status epilepticus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

Cite this

Safety and efficacy of levetiracetam for critically Ill patients with seizures. / Nau, Karen M.; Divertie, Gavin D.; Valentino, Alden K.; Freeman, William D.

In: Neurocritical Care, Vol. 11, No. 1, 08.2009, p. 34-37.

Research output: Contribution to journalArticle

Nau, Karen M. ; Divertie, Gavin D. ; Valentino, Alden K. ; Freeman, William D. / Safety and efficacy of levetiracetam for critically Ill patients with seizures. In: Neurocritical Care. 2009 ; Vol. 11, No. 1. pp. 34-37.
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AB - 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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