Keppra IV Does Not Absorb Through Intact Skin
Levetiracetam (Keppra) IV solution is not absorbed through intact skin and poses no systemic risk from dermal contact. This is because levetiracetam is a hydrophilic molecule with pharmacokinetic properties that make transdermal absorption essentially impossible under normal circumstances.
Why Levetiracetam Cannot Penetrate Skin
Molecular Properties Prevent Absorption
- Levetiracetam has unfavorable characteristics for transdermal absorption, including high hydrophilicity and a molecular weight that exceeds the ideal range for passive skin penetration 1
- Drugs suitable for transdermal delivery require a molecular weight less than 500 Da, intermediate lipid-water partition coefficient, and low ionization 1
- Levetiracetam is primarily renally eliminated (66% unchanged) with minimal metabolism, indicating it remains as a hydrophilic compound that would not partition into the lipid-rich stratum corneum 2, 3
Skin Barrier Function
- The stratum corneum acts as the primary barrier to drug absorption, and hydrophilic molecules like levetiracetam cannot effectively traverse the intercellular lipid matrix 1
- Transdermal absorption requires passage through multiple skin layers via either appendageal routes (limited to very small molecules) or transepidermal routes (requiring lipophilicity) 1
Clinical Context and Safety
IV Formulation Handling
- Levetiracetam IV is administered intravenously with rapid and complete absorption when given by the intended route 2, 3
- There are no reports in the medical literature of systemic toxicity from dermal exposure to levetiracetam IV solution, despite widespread clinical use
Subcutaneous Administration Evidence
- Subcutaneous levetiracetam has been studied for palliative care patients, with doses ranging from 250-4000 mg daily, demonstrating that even direct injection into tissue (not just surface contact) requires intentional administration 4
- One case reported a sterile abscess after 25 days of continuous subcutaneous administration, but this involved prolonged tissue exposure, not transient skin contact 4
Common Pitfall to Avoid
Do not confuse the risk of skin irritation from IV extravasation with systemic absorption. While certain medications like dopamine and epinephrine can cause severe local tissue injury when extravasated (requiring phentolamine injection for vasoconstriction reversal) 1, this represents direct tissue damage from high local concentrations, not transdermal absorption leading to systemic effects. Levetiracetam is not among the vesicant medications that cause tissue necrosis.
Practical Recommendation
Standard universal precautions for handling IV medications apply, but there is no need for special dermal protection beyond routine glove use when handling Keppra IV. If skin contact occurs, simple washing with soap and water is sufficient. Healthcare workers should focus safety concerns on proper IV administration technique rather than dermal exposure risks.