Abstracts

Rationale: Levetiracetam is a newer anticonvulsant with a pharmacolocical profile (non-protein bound, significant renal excretion, lack of enzyme induction) which facilitates is use in a wide range of complex clinical settings. The recent availability of an IV formulation potentially extends this spectrum to those patients who cannot take oral medications, including its use in patients who present with seizures while undergoing bone marrow or solid organ transplantation.Methods: A list of all patients recieving IV levetiracetam was obtained from a pharmacy database and a retrospective chart review was undertaken. Data extracted included age, sex, epilepsy syndrome, seizure type, clinical setting (intubated, neutropenic) doses used, use as loading or maintenance therapy, whether used as monotherapy or adjunctive treatment, serum concentrations where available, tolerability, efficacy and side effect profile.Results: A total of 12 patients recieved intravenous levetiracetam in the transplant setting in the period under study. All patients were undertaking complex multi-drug chemotheraputic regimes where the addition of a more commonly employed enzyme-inducing anticonvulsant like phenytoin would have sigificantly complicated or compromised the clinical protocol. IV levetiracetam was well tolerated and clinically efficacious in this population and was not associated with acute toxicity. Conclusions: Seizures in the transplant patient present a difficult theraputic challenge. Patients are frequently takiing multiple medications and if they develop seizures, may do so in the setting of severe morbidity which compromises the ability to take oral medications. The availability of another intravenous anticonvulsant agent with low protein binding, significant renal excretion and lack of enzyme induction is a welcome extension of the limited theraputic options available in this difficult clinical setting. Supported by an educational grant from UCB Pharma.