Is high-dose IV push levetiracetam safe to administer?

A recent study has provided further evidence on the safety and tolerability of rapid administration of undiluted levetiracetam, including 2,500- and 4,500-mg doses.

Researchers evaluated a total of 340 doses of levetiracetam 2,500 mg and greater throughout the study. The most common total dose was 3,000 mg, while that for weight-based dose was 50‒59.99 mg/kg. Moreover, an evaluation was also performed on 119 doses of 4,000 mg or greater.

Nearly all doses (338/340, 99.4 percent) were deemed well-tolerated. However, one patient had erythema at the injection site, while another was found to have nystagmus.

A group of researchers performed a retrospective chart review to examine adverse drug reactions following intravenous (IV) push administration of levetiracetam at a dose of 2,500 mg or greater between 5 August 2021 and 30 Juney 2022. They assessed each patient for any adverse events that occurred using provider documentation, event forms, and allergy list documentation.

“Levetiracetam is a guideline-recommended antiepileptic that has been shown to be effective in the termination of status epilepticus. Traditionally, levetiracetam is diluted in 100 mL of compatible fluid and administered as an IV piggyback over 15‒60 min,” the researchers said.

“Recent data supports the administration of levetiracetam as an undiluted IV push. However, there is limited literature supporting the safety and tolerability of undiluted IV push administration of high-dose levetiracetam,” they added.