Scientific Poster Session II - Original Research

Original Research
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Introduction: Intravenous (IV) levetiracetam is commonly used as a second-line antiseizure medication in status epilepticus due to few adverse effects and lack of therapeutic monitoring. Recent studies suggest rapid administration of high-dose undiluted levetiracetam in adults is safe; however, no such information exists in pediatric patients.

Research Question or Hypothesis: Undiluted IV levetiracetam (100 mg/mL) is safe and tolerable in doses up to 4500 mg compared to diluted levetiracetam (15 mg/mL).

Study Design: Retrospective, single-center, cohort analysis of patients who received high-dose >60 mg/kg (-10%) up to 4500 mg diluted or undiluted IV levetiracetam at a large pediatric academic medical center.

Methods: Descriptive statistics were used to characterize patient demographics, levetiracetam administration characteristics, primary outcome, and secondary outcomes. Administration of diluted vs. undiluted levetiracetam was assessed by statistical comparison tests. Comparisons of categorical data were completed using a Fischer’s exact test and continuous data was analyzed using a student t-test or Mann-Whitney U test.

Results: There were 776 levetiracetam doses included, 358 doses administered and 418 doses wasted. The doses administered (61 undiluted and 297 diluted) accounted for a total of 252 patients (39 undiluted and 213 diluted) (median [minimum/maximum range] age, 2 y [1 d–32.7 y]; mean (SD) weight, 20.1 kg (22.1 kg)). The incidence of hemodynamic disturbances and infusion related reactions was not statistically significant between groups (p= 0.87). The median (IQR) time difference between first-line and levetiracetam administration in patients with status epilepticus was 18 minutes (10.5-30.5) vs. 36.5 minutes (21.8-67.3) in the undiluted and diluted groups; p<0.01. Additionally, there was a significant amount of drug waste from dispensed but not administered doses of the diluted bag compared to undiluted vials (57.6% vs. 18.7%, p<0.01).

Conclusion: Undiluted levetiracetam was not associated with an increased incidence of adverse effects compared to diluted levetiracetam in high-doses, up to 4500 mg given over 5 minutes in pediatric patients.

Presenting Author

Lily Price PharmD
Cincinnati Children's Hospital Medical Center

Authors

Lisa Garrity PharmD
Sarah Stiehl PharmD