Can Levetiracetam (Keppra) be given intravenously (IV)?

From the Guidelines

Yes, levetiracetam can be given intravenously (IV). The IV formulation is typically used when oral administration is not feasible, such as during emergencies, perioperative periods, or when patients cannot take medications by mouth.

Key Points to Consider

• The standard IV dose for adults is equivalent to the oral dose, typically 500-1500 mg twice daily, administered as a 15-minute infusion.
• For emergency situations like status epilepticus, a loading dose of 20-60 mg/kg may be given, as seen in studies such as 1.
• The IV solution should be diluted in compatible diluents like 0.9% sodium chloride, lactated Ringer's, or 5% dextrose.
• IV levetiracetam has a bioavailability similar to oral formulations, with rapid distribution to the brain, making it effective for quick seizure control.
• The medication is generally well-tolerated when given intravenously, with similar adverse effects to oral administration, including somnolence, dizziness, and potential behavioral changes, as noted in studies like 1 and 1.

Administration and Efficacy

• Patients can typically be transitioned from IV to oral levetiracetam at the same dose once they are able to take medications by mouth.
• Studies have shown that IV levetiracetam can be effective in terminating seizure activity, with efficacy rates ranging from 44% to 73% in different studies, such as 1 and 1.
• The choice of administration route (oral vs. parenteral) depends on the discretion of the emergency physician, as there is currently a lack of evidence to support one route over the other in terms of preventing early recurrent seizure, as discussed in 1.

From the FDA Drug Label

Levetiracetam injection and tablets are bioequivalent The equivalence of levetiracetam injection and the oral formulation was demonstrated in a bioavailability study of 17 healthy volunteers. In this study, levetiracetam 1500 mg was diluted in 100 mL 0. 9% sterile saline solution and was infused over 15 minutes.

Levetiracetam can be given IV. The drug label states that levetiracetam injection is bioequivalent to the oral formulation, and a study demonstrated the equivalence of IV and oral levetiracetam in 17 healthy volunteers 2.

From the Research

Administration of Levetiracetam

• Levetiracetam can be administered intravenously (IV) as an antiepileptic drug, as well as in cases of status epilepticus 3.
• The IV formulation of levetiracetam has been shown to be bioequivalent to oral tablets, with similar pharmacokinetic profiles 4.
• Studies have demonstrated the safety and tolerability of IV levetiracetam administration, including high-dose IV push administration 5, 6.

Safety and Tolerability

• Adverse events reported after IV administration of levetiracetam were primarily related to the central nervous system (CNS), such as dizziness, somnolence, and fatigue 4, 6.
• High-dose IV push administration of levetiracetam (2500 mg to 4500 mg) was found to be safe and tolerable in a retrospective chart review study 5.
• The pharmacokinetics of levetiracetam administered by IV infusion were comparable across all dose groups and infusion rates, with no clear relation noted between incidence of adverse events and IV dose level or infusion rate 6.

Dosing Considerations

• Optimal levetiracetam dosing regimens for patients receiving continuous renal replacement therapy (CRRT) have been defined using Monte Carlo simulation, with recommended dosing regimens of 750-1000 mg every 12 hours for adult patients 7.
• Child-Pugh class C cirrhotic patients undergoing CRRT may require lower dosing regimens due to smaller non-renal clearance 7.