Intravenous Push Levetiracetam Administration Compared With Intravenous Piggyback on Benzodiazepine Use for Acute...

Levetiracetam (LEV) is indicated for benzodiazepine (BZD) refractory status epilepticus (SE) and is traditionally administered as an intravenous piggyback (IVPB) infused over 15 min, although rapid intravenous push (IVP) administration over 2 to 5 min has gained popularity. Current literature surrounding IVP LEV administration supports increased efficiency and equal safety of IVP compared with IVPB, though efficacy comparisons, such as seizure duration, are limited. The objective of this study was to assess the impact of IVP LEV on seizure duration and BZD requirements.

This retrospective cohort study assessed adult patients who received IVP or IVPB LEV following a BZD for an acute or suspected seizure. The primary outcome was the number of patients who required additional BZD doses between LEV order and administration. Secondary outcomes included additional BZD requirement within 6 h after LEV administration, time from LEV order to administration, need for intubation, and intensive care unit (ICU) admission. Safety outcomes assessed included bradycardia, hypotension, and infusion site reactions.

A total of 299 patients were included, 144 in the IVP group and 155 in the IVPB group. Fewer patients required additional BZD doses between LEV order and administration in the IVP group than the IVPB group (8 patients [5.6%] vs. 27 patients [17.4%]; p = 0.002). Additionally, the median time from LEV order to administration was shorter in the IVP group than in the IVPB group (14.5 min vs. 29.0 min; p < 0.001). Bradycardia occurred more frequently in the IVPB group compared with the IVP group (8.8% vs. 2.3%; p = 0.03).

IVP LEV was associated with less frequent requirement of additional BZD doses for treatment of acute or suspected seizures compared with IVPB, as well as a faster time to medication administration and potentially a lower risk of bradycardia.