From the Guidelines
A patient who has not taken her antiepileptic medication for two months and experiences a seizure in the hospital would typically benefit from a loading dose, as this approach helps to quickly achieve therapeutic levels and reduce the risk of recurrent seizures. The specific approach depends on the medication previously prescribed. For example, if the patient was on levetiracetam, a loading dose of 1,500 mg oral load or rapid IV loading safe and well tolerated in doses up to 60 mg/kg can be administered, as shown in a study published in the Annals of Emergency Medicine 1. This study provides guidance on loading dose and route of administration strategies for antiepileptic medications in the emergency department setting.
Some key considerations for loading doses of different antiepileptic medications include:
- Phenytoin: 20 mg/kg divided in maximum doses of 400 mg every 2 h orally, or 18 mg/kg IV at maximum rate of 50 mg/min, with a higher risk of adverse effects with IV administration 1
- Valproate: up to 30 mg/kg IV at max rate of 10 mg/kg/min IV, with transient local irritation at injection site as a potential adverse effect 1
- Levetiracetam: 1,500 mg oral load; rapid IV loading safe and well tolerated in doses up to 60 mg/kg, with fatigue, dizziness, and rarely pain at infusion site as potential adverse effects 1
After the loading dose, maintenance therapy should be promptly initiated to ensure continuous therapeutic levels and minimize the risk of recurrent seizures. The specific loading regimen should be tailored to the patient's weight, renal and hepatic function, and history of medication tolerance, with close monitoring for adverse effects during administration.
From the Research
Loading Dose for Seizure Patients
- If a patient has not taken their medication for two months and experiences another seizure in the hospital, the need for a loading dose depends on various factors, including the type of medication and the patient's individual circumstances.
- According to a study on status epilepticus, a loading dose of sodium valproate (30 mg/kg) or intravenous phenytoin (20 mg/kg) is commonly administered to rapidly achieve therapeutic levels 2.
- However, the provided studies do not directly address the specific scenario of a patient who has not taken their medication for two months and requires a loading dose.
- A study on treatment non-adherence as a trigger for status epilepticus highlights the importance of therapeutic drug monitoring to identify non-adherence, but does not provide guidance on loading doses 3.
- Other studies discuss the importance of adherence to antiepileptic drug treatment regimens and the consequences of non-adherence, but do not address the specific question of loading doses 4, 5, 6.