17-Safety of Intravenous Push Levetiracetam Administration at a Tertiary Academic Medical Center
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Pharmacology, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Afrah Alkazemi


Introduction/Hypothesis: Recent shortages of intravenous (IV) fluids has resulted in many health care systems converting medications from IV piggyback (IVPB) to IV push (IVP). In 2019, Brigham and Women's Hospital changed several medications to IVP; which included levetiracetam. Administering medications via IVP presents multiple advantages such as reduced drug/material cost, improved workflow, and shorter time to first dose, however there may be a risk of increased adverse drug reactions. The purpose of this analysis was to compare the safety profile including both systemic side effects and IV site reactions of IVP to IVPB levetiracetam.

Methods: This IRB approved, single-center, pre-post analysis was performed between November 1, 2019 and May 30, 2020 at Brigham and Women's Hospital in Boston, Massachusetts. The electronic health record was used to identify all administrations of IV levetiracetam greater than 1 g in patients ≥ 18 years old. The primary endpoints included hypotension, bradycardia, drug-induced sedation and IV site reactions such as phlebitis and infiltration. The Naranjo Nomogram was utilized to evaluate all drug reactions to determine the likelihood of whether the event was due to levetiracetam rather than other factors, such as concomitant medications.

Results: A total of 522 administrations in 165 patients were included in the analysis: 267 administrations in 86 patients in the IVP group and 255 administrations in 79 patients in the IVPB group. The median dose administered in both groups was 2 g. The incidence of hypotension in the IVP vs. IVPB groups was 10 vs. 7 (3.8% vs. 2.7%, p=0.075); bradycardia 13 vs. 4 (4.9% vs. 1.6%, p=0.054); sedation 21 vs. 37 (7.9% vs. 14.5%, p=0.039); and IV site reactions 0 vs. 2 (0% vs. 0.8%, p=0.238), respectively. Sixteen of the 44 (36.4%) events in the IVP group were deemed 'possible' with 3 assessed as 'probable' per the Naranjo Nomogram. In the IVPB group, 33 (66%) were found to be 'possible' on the Naranjo Nomogram while 5 were assessed as 'probable'.

Conclusions: The administration of levetiracetam via IVP had a similar safety profile compared to IVPB. Intravenous levetiracetam in doses as high as 4 g may be considered safe for IV push administration with appropriate monitoring.


Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Level Advanced
Membership Level Select
Tag Seizure
Year 2021
intravenous push
anti-epileptic drug
safety profile
Brigham and Women's Hospital


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