What is the administration protocol for Inj Levipil (Levetiracetam) 500mg in 50ml Normal Saline (NS)?

Levetiracetam 500mg IV Administration Protocol

Administer levetiracetam 500mg intravenously over 5 minutes as an undiluted or minimally diluted bolus through either peripheral or central access, followed by a 5-10 mL normal saline flush. 1, 2

Preparation and Dilution

• Levetiracetam 500mg can be administered undiluted (100 mg/mL concentration from a 5 mL vial) or minimally diluted in 50 mL normal saline as you've described 1, 2
• The undiluted/minimally diluted approach is supported by multiple studies demonstrating safety with doses up to 4,500 mg administered as rapid bolus 1, 2
• If using 50 mL NS dilution, infuse over 5-15 minutes rather than the traditional 15-minute minimum 2

Administration Rate and Route

• Rapid infusion over 5 minutes is safe and well-tolerated for doses ranging from 280-4,500 mg 1, 2
• Both peripheral and central venous access are acceptable routes 1, 2
• The traditional FDA-approved 15-minute infusion can be safely shortened to 5 minutes without increased adverse effects 2

Post-Administration Flush

• Immediately follow with 5-10 mL normal saline flush using rapid push technique 3
• This flush volume ensures medication clears the catheter dead space and reaches central circulation 3
• Use push-pause (turbulent) flushing technique rather than continuous pressure for optimal catheter clearance 3

Safety Profile

• Adverse effects are minimal with rapid administration, most commonly including injection site pain and agitation 1
• No significant cardiovascular instability, respiratory depression, or infusion-related reactions have been reported with rapid bolus administration 1, 2
• Peripheral line administration does not increase risk of tissue injury or phlebitis 2

Clinical Context

• For status epilepticus or acute seizures, rapid administration allows faster attainment of therapeutic levels compared to traditional 15-minute infusion 2
• Maintenance dosing up to 1,500 mg twice daily can be safely administered using this rapid technique 1
• Starting dose for prophylaxis is typically 500 mg twice daily, with goal dosing of 1,000-2,000 mg daily in divided doses 4

Key Advantages

• Reduces unnecessary fluid volume administration, particularly important in fluid-sensitive patients 1
• Faster therapeutic drug levels achieved compared to traditional infusion rates 2
• No requirement for infusion pumps when given as undiluted push, simplifying administration 1