Safety of Intravenous Push Levetiracetam in an Academic Children's Hospital

Background: Evidence supports the safe administration of levetiracetam as a rapid intravenous push (IVP) in patients experiencing breakthrough seizures or status epilepticus. Use of this route of administration may decrease morbidity and mortality by reducing time to medication delivery. Though this practice has become increasingly common in adults, the safety of IVP levetiracetam in pediatric patients is not well documented. Objective: To evaluate the safety of IVP levetiracetam in pediatric patients. Methods: Patients who received IV piggyback (IVPB) or IVP levetiracetam and were between the ages of 12 months and 18 years old were eligible for inclusion. Medication regimen data recorded includes the dose of levetiracetam, number of doses administered, and total days of administration. Additionally, time points related to order entry, pharmacist verification, and dose administration was recorded. Safety endpoints included rates of bradycardia, hypotension, behavioral changes, and cutaneous drug reactions. Descriptive and inferential statistical analysis was performed using SPSS software. Results: This study showed IVP levetiracetam has a similar rate of adverse effects when compared to IVPB levetiracetam in patients over the age of one (5.5% vs 7.5%, P = 0.3589). In addition, there was improvement in the time to administration of levetiracetam (50 min in the IVPB group and 23 min in the IVP group [P = .0008]). Conclusion: Pediatric patients who received undiluted (100 mg/mL) levetiracetam IVP over 5 min had a similar adverse event incidence when compared to those who received the anti-epileptic drug (AED) as an IVPB. This evaluation demonstrated that doses up to 1500 mg of undiluted IVP levetiracetam is safe for pediatric patients.