Pharmacokinetic considerations surrounding the use of levetiracetam for seizure prophylaxis in neurocritical care – an overview

ABSTRACT

Introduction

Levetiracetam (LEV) is one of the most widely used anti-seizure medications (ASMs) in clinical practice. This is due both to a different mechanism of action when compared to other ASMs and its easy handling. Indeed, because of its interesting pharmacokinetic properties, it is often used outside of the labeled indications, notably in the neurocritical setting as prophylaxis of epileptic seizures.

Areas covered

A literature search was conducted and the most relevant studies on the pharmacokinetic properties of LEV were selected by two independent investigators. Current evidence on the use of ASM prophylaxis in the neurocritical setting was also reviewed, highlighting and discussing the strengths and limits of LEV as drug of choice for anti-epileptic prophylaxis in this scenario.

Expert opinion

LEV has a ‘near-ideal’ pharmacokinetic profile, which makes it an attractive drug for ASM prophylaxis in neurocritical care. However, current recommendations restrict ASMs prophylaxis to very selected circumstances and the role of LEV is marginal. Moreover, studies are generally designed to compare LEV versus phenytoin, whereas studies comparing LEV versus placebo are lacking. Further, randomized trials will be needed to better elucidate LEV utility and its neuroprotective role in the neurocritical setting.

KEYWORDS:

• Levetiracetam
• neurocritical care
• pharmacokinetic
• prophylaxis
• anti-seizure medications

Article highlights

• Levetiracetam (LEV) is a widely prescribed anti-seizure medication with a favorable pharmacokinetic profile.

• LEV is rapidly absorbed, and its excretion is purely renal. It is available both in intravenous and oral formulations, and it has few pharmacokinetic interactions with other drugs.

• Despite the extensive use of LEV as antiepileptic prophylaxis in the neurocritical setting supporting evidence is controversial.

• Future randomized clinical trials are needed to assess the real effectiveness of LEV in this clinical scenario.

Declaration of interest

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

This paper was not funded.