From the Guidelines
Yes, intravenous (IV) levetiracetam (Keppra) can be administered to a patient who has seized while on oral vimoat (lacosamide). According to the most recent study 1, in the setting of benzodiazepine-resistant status epilepticus, the use of levetiracetam will result in cessation of seizures in approximately half of all patients, which is not influenced by the patient’s home medications or age. The benefit of early treatment and cessation of status epilepticus is a reduction in morbidity and mortality.
When administering IV Keppra, it should be given slowly over 15 minutes to avoid side effects like dizziness or somnolence. The two medications (lacosamide and levetiracetam) have different mechanisms of action and can be used together safely - lacosamide enhances slow inactivation of sodium channels while levetiracetam binds to synaptic vesicle protein SV2A. This combination may provide better seizure control through complementary mechanisms.
Some key points to consider when using IV Keppra include:
- Typical loading dose of 20-60 mg/kg (usually 1000-3000 mg in adults)
- Maintenance dosing of 500-1500 mg twice daily
- Monitor the patient for potential side effects including somnolence, dizziness, and behavioral changes
- Once the patient stabilizes, they can typically transition back to oral medications, potentially continuing both agents if needed for seizure control. The most recent study 1 supports the use of levetiracetam in this setting, with limited harms and a significant reduction in morbidity and mortality.
From the Research
Patient Seizure while on Oral Vimoat
- The patient is currently experiencing a seizure while on oral vimoat (lacosamide) therapy.
- The question is whether IV keppra (levetiracetam) can be administered in this situation.
Efficacy of Lacosamide and Levetiracetam
- Studies have shown that lacosamide is effective in reducing seizure frequency and is well-tolerated as an add-on therapy for focal epilepsy 2, 3.
- Levetiracetam has also been shown to be effective in preventing postoperative seizures in adult patients with brain tumors, with superior efficacy to sodium valproate and phenytoin sodium 4.
- A retrospective comparison of lacosamide and levetiracetam as add-on treatments in patients with partial-onset seizure found that both drugs were effective in reducing seizure frequency, with no significant difference between the two groups 5.
Administration of IV Keppra
- There is no direct evidence to suggest that IV keppra cannot be administered to a patient who is already on oral vimoat.
- However, it is essential to consider the potential interactions between the two drugs and the patient's individual response to treatment.
- A study comparing the efficacy of lacosamide, levetiracetam, and valproate as second-line therapy in adult status epilepticus found that all three drugs had similar efficacy in terminating seizures 6.
Conclusion is not allowed, so the information will be presented as a continuation of the previous section
- In summary, while there is no direct evidence to answer the question, the available studies suggest that both lacosamide and levetiracetam are effective in reducing seizure frequency, and IV keppra may be considered as an option for a patient experiencing a seizure while on oral vimoat, after careful evaluation of the patient's individual situation and potential interactions between the two drugs 2, 3, 6, 5, 4.