Friday, April 18, 2008

Friday April 18, 2008
IV Levetiracetam - a new arsenal to treat Status Epilepticus

Status Epilepticus (SE) remains one of the difficult areas in the management of critically ill patients despite availability of several modalities with mortality rate of over 20%. To prevent brain injury, intervention, early intervention is important. Midazolam, pentobarbital, propofol and topiramate are the common drugs used at present.

levetiracetam (Keppra) which was only available as PO agent is now available in IV form also, and is one of newer agents which has shown efficacy in SE. It seems to be a very promising agent in the critically ill patients with SE. Please refer to references below:

Unlike Dilantin, it does not require blood level measurement.

Dosage: Treatment should be initiated with a daily dose of 1000 mg/day, given as twice-daily dosing. Maximum recommended daily dose is 3000 mg. Dosage adjustments are necessary in patients with impaired renal function.
Recommended dosage for ESRD patients on dialysis is 500-1000 mg q24 hours, with a 250 to 500 mg supplemental dose is recommended following dialysis.



References: click to get abstract / article

1.
Intravenous levetiracetam: Treatment experience with the first 50 critically ill patients - Epilepsy Behav. 2008 Apr;12(3):477-80. Epub 2008 Mar 4.
2.
The use of levetiracetam in refractory status epilepticus - Seizure. 2006 Apr;15(3):137-41. Epub 2006 Jan 19.
3.
Keppra - fda.gov - pdf file
4. L
evetiracetam/Keppra - globalrph.com