In this episode, I’ll discuss the efficacy of IV push levetiracetam over slow IV infusions.
IV levetiracetam is FDA labeled to be infused slowly, over 15 min. Rapid IV push administration has gained popularity with several studies supporting its safety, and some of these have been discussed recently in episode1056. However, until now, there has not been any data comparing the efficacy of IV push levetiracetam with that of a slower 15 minute infusion.
A group of authors published in Pharmacotherapy a retrospective cohort study to evaluate the efficacy of IV push levetiracetam on seizure duration and benzdiazepine requirements when compared to a 15 minute IV piggyback infusion.
The authors compared 144 patients who received levetiracetam IV push with 155 who received it IV piggyback. The primary outcome was the number of patients who required additional benzodiazepine doses between the levetiracetam order and administration. Secondary outcomes included additional benzodiazepine requirement within 6 hours after levetiracetam administration, time from levetiracetam order to administration, need for intubation, and intensive care unit admission.
Only 5.6% of the patients in the IV push group required additional benzodiazepine doses between levetiracetam order and administration, compared to 17.4% in the IV piggyback group. This difference was statistically significant. Additional measurements in favor of IV push administration were a 15 minute shorter median time from order to administration, and a ~75% reduction in the rate of bradycardia.
The authors concluded:
IVP LEV was associated with less frequent requirement of additional BZD doses for treatment of acute or suspected seizures compared with IVPB, as well as a faster time to medication administration and potentially a lower risk of bradycardia.
If you haven’t already made the switch to IV push administration of levetiracetam at your institution due to concerns about efficacy, this study should help convince any holdouts.
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.
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