18-Evaluation of Intravenous Push Levetiracetam in a Neurospine Intensive Care Unit
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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.

Tori Adams


Introduction/Hypothesis: The purpose of this study was to evaluate the time to therapy, the clinical effect and safety of a recent Pharmacy and Therapeutics (P&T) Committee approved change in the administration of levetiracetam from intravenous piggy back (IVPB) over 15 minutes to undiluted intravenous push (IVP) over 2-5 minutes at a large academic medical center.

Methods: The primary outcome was the time from order verification to administration of IVP levetiracetam versus IVPB levetiracetam. The secondary outcome was any benzodiazepine administered in the time between levetiracetam order verification and administration in both groups. Adult patients admitted to the Neuro-Spine Intensive Care Unit (NSICU) in the 6 months prior to and after the policy change who received at least 1 dose of ≥ 1000 mg of IVP or IVPB levetiracetam for active seizures were included in this retrospective, observational, IRB approved study. Data was analyzed using descriptive statistics, Chi-square and Mann-Whitney U as appropriate.

Results: Of the 2,055 levetiracetam doses ordered in the study period, 316 were screened for enrollment, and 160 were enrolled with 60 and 100 patients assigned to the IVP and IVPB groups, respectively. There were no differences between groups at baseline. The majority of the population was male, 57 years old, without significant renal dysfunction (CrCl <60ml/min), and a seizure etiology of malignancy or traumatic brain injury. A significant reduction in time to administration of levetiracetam was found with IVP compared to IVPB administration (28 vs 80 minutes, p<0.0001). A subsequent reduction in patients who received benzodiazepines in the interim of levetiracetam order verification and administration was also associated with IVP compared to IVPB (2% vs 13%, p=0.042). There were no differences found in rates of adverse effects between groups.

Conclusions: Administration of levetiracetam doses up to 2000mg via IVP is a safe method of administration that results in reduction of time to medication administration and a consequent reduction of benzodiazepine use.


Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Level Advanced
Membership Level Select
Tag Seizure
Year 2021
Tori Adams
intravenous push levotriacetam
neurospine ICU
pediatric patients
adult patients


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