From the Guidelines
It is acceptable to start a naloxone (Narcan) drip after administering a levetiracetam (Keppra) loading dose, as there is no significant interaction between the two medications that would contraindicate their concurrent use. According to the study published in the Annals of Emergency Medicine 1, levetiracetam can be loaded orally or intravenously, with a dose of 1,500 mg oral load or rapid IV loading safe and well tolerated in doses up to 60 mg/kg. The study does not mention any interactions with naloxone, suggesting that the two medications can be used together without significant concern.
When initiating a naloxone drip, the typical starting dose is 0.04-0.08 mg/kg/hr after an initial bolus, titrated to clinical response. It is essential to monitor the patient closely for signs of opioid withdrawal if they are opioid-dependent, as naloxone can precipitate withdrawal symptoms. Additionally, watch for the return of respiratory depression as naloxone has a shorter duration of action than many opioids.
Key considerations when using these medications together include:
- Monitoring the patient's neurological status to ensure the levetiracetam is effectively controlling seizure activity
- Watching for signs of opioid withdrawal or return of respiratory depression
- Carefully evaluating the clinical scenario to ensure appropriate treatment of the underlying conditions
- Being aware of the potential for levetiracetam to cause fatigue, dizziness, or pain at the infusion site, as noted in the study 1.
Overall, the use of naloxone and levetiracetam together should be guided by the patient's specific clinical needs and monitored closely to ensure effective treatment of both conditions.
From the Research
Administration of Narcan Drip after Keppra Loading Dose
- There is no direct evidence in the provided studies to suggest that a Narcan drip should be started after a Keppra loading dose 2, 3, 4, 5, 6.
- Keppra (levetiracetam) is an anticonvulsant used to treat partial complex seizures and does not appear to directly interact with the GABA system 2.
- The studies provided focus on opioid overdose and the use of naloxone (Narcan) to reverse opioid-induced respiratory depression 3, 4, 5.
- One study discusses the tolerability and efficacy of oral loading of levetiracetam, but does not mention the use of Narcan 6.
- Another study reports a case of levetiracetam overdose, which resulted in sedation and respiratory depression, but the treatment involved supportive care and not Narcan 2.
Key Considerations
- The decision to start a Narcan drip should be based on the patient's clinical presentation and medical history, rather than the administration of a Keppra loading dose.
- Naloxone is used to reverse opioid-induced respiratory depression, and its use should be guided by the patient's symptoms and medical history 3, 4, 5.
- The provided studies do not support the routine use of Narcan after a Keppra loading dose, but rather emphasize the importance of individualized patient care and treatment decisions based on clinical presentation and medical history.