Is it safe to crush Keppra (levetiracetam)?

Crushing Keppra (Levetiracetam) Tablets

Yes, it is safe to crush Keppra (levetiracetam) tablets for administration. Crushing levetiracetam tablets does not significantly affect the drug's absorption or efficacy, making it a viable option for patients who have difficulty swallowing whole tablets.

Administration of Crushed Levetiracetam

• Crushed levetiracetam tablets can be mixed with water or food vehicles without significantly impairing the overall rate and extent of absorption 1
• When administering through enteral feeding tubes, crushed tablets should be suspended in water and administered immediately 1
• The bioavailability of crushed levetiracetam remains comparable to intact tablets, though peak serum concentrations may be slightly reduced when mixed with enteral nutrition formulas 1
• Studies have shown that crushing and mixing levetiracetam with applesauce or enteral nutrition formulas does not significantly alter its pharmacokinetic profile 1, 2

Best Practices for Crushing Medications

• Use dedicated crushing equipment for each patient to prevent cross-contamination 3
• Crush tablets thoroughly to ensure complete dissolution 3
• Mix crushed tablets with appropriate vehicles such as water or jellified water 3
• Avoid mixing with substances that might interact with the medication (such as certain juices or foods that could affect absorption) 3

Clinical Applications

• Crushed levetiracetam has been successfully used in various clinical settings, including:
  • Administration via nasogastric or orogastric tubes 2
  • Administration to patients who have difficulty swallowing, such as elderly patients or those with neurological conditions 3
  • Emergency administration in status epilepticus when IV formulations are unavailable 2

Safety Considerations

• Even in significant overdose situations, levetiracetam has demonstrated a relatively favorable safety profile, suggesting that minor variations in dosing due to crushing are unlikely to cause harm 4, 5
• The therapeutic window of levetiracetam is relatively wide, with documented cases of substantial overdoses resulting in minimal clinical consequences 4, 5

Specific Administration Guidelines

• For oral administration: Mix crushed tablet with small amount (1-2 tablespoons) of soft food like applesauce 1
• For enteral tube administration: Crush tablet thoroughly and suspend in 50-60 mL of water 1
• Administer immediately after preparation to ensure stability 1
• Follow administration with adequate water flush to ensure complete delivery of medication 1

Cautions

• While crushing is safe, it's important to ensure the entire dose is administered to maintain therapeutic efficacy 3
• Avoid crushing extended-release formulations of other medications, as this can alter their pharmacokinetics and potentially cause toxicity 3
• When administering multiple crushed medications, give them separately to avoid potential interactions 3

Levetiracetam's pharmacokinetic properties make it particularly suitable for administration as a crushed tablet, with studies confirming that this method of administration maintains its therapeutic efficacy 1, 2.