好色先生

好色先生

Explore the latest content from across our publications

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Optimal Dose of Levetiracetam for Seizure Prophylaxis in Neurocritical Care Patients
Neuro Trauma, Critical Care, and Sports Neurology
Neurocritical Care Posters (7:00 AM-5:00 PM)
032
To determine the dose of prophylactic levetiracetam (fixed and mg/kg dose) that most consistently generates therapeutic trough levels (12–46 μg/ml).
The use of prophylactic anticonvulsants among neurocritically ill patients has been controversial.  Variable results in studies of prophylactic levetiracetam may be due, in part, to underdosing and failure to obtain therapeutic levels.  

A prospective observational study was conducted between 7/2019-2/2020 in consecutive adult neurocritical care patients that received levetiracetam for seizure prophylaxis. Patients with history of seizure, anti-epileptic drug use or renal failure requiring dialysis were excluded. Serum samples were collected prior to administration of the 4th dose. 

A total of 57 patients were evaluated (mean age 61 years [range 19-99]; 46% female). Indications for seizure prophylaxis included traumatic brain injury (N=25, 44%), aneurysmal subarachnoid hemorrhage (N=7, 12%), craniectomy/craniotomy (N=22, 39%),  AVM (N=1, 2%), ICH (N=1, 2%), and stroke (N=1, 2%). The most common loading dose was 1000 mg (65% of patients, range 500-3000 mg) and the most common maintenance dose was 500 mg BID (67% of patients, range 500-2000 BID).  Subtherapeutic levels occurred in 27 (47%) of patients.  Supratherapeutic levels occurred in 3 (1%) patients (N=1 500 BID, N=1 1000 BID and N=1 2000 BID).  Of the patients that received 500mg (N=38), 750mg (N=6), 1000mg (N=11), and 2000mg BID (N=2) maintenance doses, subtherapeutic levels occurred in 55%, 50%, 27% and 0%, respectively.  Patients who received 1000 mg BID (median 11 mg/kg/dose) had the highest percentage of therapeutic levels (64%).    A maintenance dose of 500 mg BID (median 7 mg/kg/dose) was associated with a likelihood ratio of 2.9 for subtherapeutic levels (P=0.088). 
Over 50% of patients who received 500 mg BID (7 mg/kg/dose) maintenance levetiracetam dosing had subtherapeutic levels, while 1000 mg BID (11 mg/kg/dose) was more likely to generate therapeutic levels. 
Authors/Disclosures
Eduard H. Valdes, MD (Columbia University Irving Medical Center)
PRESENTER
Dr. Valdes has received research support from a T32 NIH Grant.
Taolin Fang, MD Dr. Fang has nothing to disclose.
No disclosure on file
Michael Boffa, MD Dr. Boffa has received personal compensation for serving as an employee of Jazz Pharmaceuticals. An immediate family member of Dr. Boffa has received personal compensation for serving as an employee of Biogen. Dr. Boffa has stock in Jazz Pharmaceuticals. An immediate family member of Dr. Boffa has stock in Biogen.
Jennifer A. Frontera, MD (NYU Langone Health) Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FirstKindMedical. Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Physician 好色先生 Resource. The institution of Dr. Frontera has received research support from NIH. The institution of Dr. Frontera has received research support from Alexion. Dr. Frontera has received publishing royalties from a publication relating to health care.