(1017) Safety of Intravenous Push Administration of High-Dose Levetiracetam

Introduction: Levetiracetam administration via intravenous push (IVP) may improve outcomes in status epilepticus (SE) by decreasing time to administration. However, there is a paucity of literature describing the safety of IVP administration of higher levetiracetam loading doses typically used for early management of SE. The objective of this evaluation was to investigate the safety of IVP levetiracetam doses ≥3000 mg.

Methods: This was a retrospective, single-arm quality improvement project conducted at an academic medical center. Patients were included if they received an IVP dose of levetiracetam ≥3000 mg. The primary outcome was a composite endpoint of clinically significant adverse events (AEs) within 1 hour post-administration of levetiracetam: Hypotension, hypertension, bradycardia, tachycardia, arrhythmia, and/or an injection site reaction.

Results: 141 patients met inclusion criteria, receiving a median levetiracetam dose of 4000 mg (IQR 3000, 4500). Eighteen (12.8%) patients experienced a clinically significant AE within 1 hour post-administration of levetiracetam. The most common AE was hypotension (10.0%), followed by tachycardia (3.5%), arrhythmia (1.8%), hypertension (0.9%), and injection site reaction (0.7%). Compared to the total cohort, patients who experienced clinically significant hypotension had higher concomitant receipt of propofol (45.5% vs. 19.1%), IV anti-arrhythmic agents (18.2% vs. 3.5%), dexmedetomidine (9.1% vs. 3.5%), and milrinone (9.1% vs. 1.4%).

Conclusions: In this single-arm retrospective analysis, high-dose (≥3000 mg) IVP levetiracetam was relatively well-tolerated but associated with a higher rate of clinically significant hypotension than has been reported in previous literature. Our findings support the continued use of high-dose IVP levetiracetam with appropriate hemodynamic monitoring; these hemodynamic effects should be further explored in future studies.