SCCM Resource Library-Drug Shortage Alert: Antiepileptics

Pdf Summary

The Drug Shortage Alert focuses on the current scarcity of intravenous antiepileptic drugs (AEDs), last updated in September 2022. This update provides guidance on managing shortages of key IV AEDs such as fosphenytoin/phenytoin, lacosamide, levetiracetam, valproic acid, and phenobarbital. Due to the potential for adverse events associated with switching between these drugs, education for clinicians is emphasized to reduce risks.<br /><br />Management strategies include reserving AEDs for specific clinical scenarios, with potential alternatives like benzodiazepines and brivaracetam, although they may also be in short supply. Transitioning from IV to oral formulations is suggested when possible, and monitoring is crucial, with considerations like dose adjustments for renal or hepatic impairment. The document also addresses safety strategies for less commonly used drugs and highlights the need for education due to differing administration rates and dosing units.<br /><br />The document mentions that drug interactions, administration routes, and patient history should be considered when selecting alternatives during drug shortages. It provides detailed pharmacotherapeutic guidelines for using and monitoring each drug, considering bioavailability and potential adverse effects. Emphasis is placed on the need for clear communication to inform clinicians on prescribing these medications accurately, with institutions encouraged to form groups for shortage mitigation strategies and education.<br /><br />Additionally, the financial impact of increased use of newer, costly AEDs like lacosamide is noted. Costs of these drugs are provided, based on average wholesale prices. The alert concludes with contact details for feedback and emphasizes that practitioners should consult internal policies to align with their institution's response to these shortages.

Asset Subtitle

Pharmacology, Crisis Management, 2022, 0:09:33

Asset Caption

"Updated September 2022

When shortages of antiepileptic drugs (AEDs) exist, there may be alternatives available. However, there are significant differences in product administration that may result in adverse drug events. Therefore, education of clinicians is necessary to limit risks to the patient. In this alert, we will discuss five commonly used IV AEDs: fosphenytoin/phenytoin, lacosamide, levetiracetam, valproic acid, and phenobarbital, which is an alternative therapy when other AEDs are not available. This summary provides information in the event of a shortage(s) and its impact on adult and pediatric patients by providing potential management strategies, pharmacotherapeutic considerations, and safety implications. The recommendations provided here are based on both current evidence, including a review of available literature by the SCCM Drug Shortages and Medication Safety Committee, and the need for conservation during this shortage.

Recommendations and information provided in this Drug Shortage Alert are compiled by experts in the field. Practitioners are advised to consult with their institution’s staff to ensure that response to any drug shortage is in line with internal policies and procedures.
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Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Seizure

Tag Resource Allocation

Year 2022

Keywords

drug shortage

intravenous antiepileptic drugs

fosphenytoin

lacosamide

levetiracetam

valproic acid

phenobarbital

management strategies

pharmacotherapeutic guidelines

financial impact

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