Clinical considerations for rapid administration of undiluted or minimally diluted levetiracetam bolus doses

ABSTRACT

Introduction

The ability to administer medications via rapid intravenous bolus has the potential to allow for the rapid attainment of therapeutic drug levels and to limit the amount of unnecessary fluid volumes infused. The purpose of this review was to evaluate the efficacy and safety of undiluted or minimally diluted levetiracetam bolus doses.

Areas Covered

A total of six pieces of the literature were evaluated in this review. Doses of up to 4,500 mg of intravenous levetiracetam were found to be both efficacious and safe when administered undiluted or minimally diluted in either a peripheral or central line. Product concentrations of levetiracetam ranged from 50 mg/mL to 100 mg/mL, with volumes ranging from 10 to 30 mL. Maintenance doses of up to 1,500 mg twice daily were demonstrated to be both efficacious and safe when administered undiluted or minimally diluted. Injection site pain and agitation were the most commonly reported adverse drug effects.

Expert Opinion

Although hospitals and clinicians must be judicious with regard to training and the safety concerns of bolus intravenous push doses, and will need to address numerous logistical concerns, this practice is supported by practice guidelines and should be readily employed.

KEYWORDS:

• Status epilepticus
• seizure
• levetiracetam
• evidence-based medicine
• clinical pharmacy
• fluid status
• medication efficacy
• medication safety

Article highlights

• Topical review of current loading dose strategies for intravenous levetiracetam

• Evaluation of efficacy and safety data associated with rapid administration of undiluted intravenous bolus doses of levetiracetam

• Discussion of the benefits of limiting insensible fluid administration as a result of intravenous medication use

• Appraisal of safety concerns regarding administration technique

• Assessment of financial incentives to adopt the proposed administration strategy

Declarations of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.