In this episode, I’ll discuss the rapid administration of antiseizure medications.
While the antiseizure medications lacosamide, levetiracetam, and valproate were initially labeled to be given via slow IV minibag infusion, evidence has continually been published supporting IV push administration over a few minutes for these medications. However, old habits die hard, and many clinicians still prefer to administer these medications via slow IV minibag infusion. Changing to a more rapid IV push infusion might be beneficial for patients, as prolonged seizures can lead to irreversible negative effects, and presumably faster administration of antiseizure medications will lead to faster resolution of seizures.
To that end, a group of authors conducted a review titled Rapid administration of antiseizure medications: Review of safety, effectiveness, and implications for pharmacy practice and published in American Journal of Health System Pharmacy. The authors provide a thorough review of evidence supporting IV push administration of these 3 medications. A total of 45 articles were analyzed for the review. The authors found that IV push administration for all three medications was a safe and efficient method of administration. Lacosamide had studies that supported IV push administration in as few as 5 to 10 minutes, and levetiracetam and valproate had studies that supported IV push administration in as few as 2 to 10 minutes.
The only safety concern that arose was a slight 10 ms prolongation of the PR interval with rapid lacosamide administration; however, the clinical significance of this appears to be minimal.
There are several operational concerns that must be addressed before transitioning to IV push administration, including drug storage and nursing practices, as well as the use of a syringe pump. However, this review article can be used to support the safety and efficiency of IV push administration of these 3 antiseizure medications.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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