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 situations. The recent availability of an IV formulation potentially extends this spectrum of use to the acute setting including its use in the Emergency Room, particularly when the use of more commonly used agents like phenytoin is clinically difficult. Methods: A list of all patients recieving IV levetiracetam was obtained from a pharmacy database and a retrospective chart and electronic medical record review was undertaken. Data extracted included age, sex, epilepsy syndrome, comorbid conditions, seizure type, clinical scenario (first seizure, recurrent seizures, concomitant anticoagulant use) 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: Intravenous levetiracetam was used in 20 patients in the emergency room setting. A majority of the patients were not taking oral levetiracetam before presentation to the ER. The most common rationale for its use appeared to be presence of complex clinical situation involving the use of multiple medications, particularly patients recieving Coumadin. Levetiracetam was used both as high dose initial loading therapy (defined as a first IV dose of 1,000mgs or greater) or as maintenance therapy. The formulation was not associated with any acute adverse events in the ER and subsequent tolerability was supported by the fact that the majority of patients were discharged on maintenace oral levetiracetam therapy. Conclusions: Intravenous levetriacetam appears to be a useful addition the limited range of intravenous anticonvulsants available for use in the acute setting, in this case the Emergency Room. Its pharmacological profile recommends it use in particular in the patient taking multiple other medications where the addition of a more commonly used agent like phenytoin would potentially complicate therapy. Supported by an educational grant from UCB Pharma.