Rapid intravenous infusion of levetiracetam - Tolerability and pharmacokinetics in elderly epileptic patients

Purpose Levetiracetam (LEV) is a new antiepileptic drug which is increasingly being used intravenously as acute therapy for epileptic seizures and status epilepticus. Due to its minimal adverse events and the lack of a hepatic metabolism it is a suitable alternative in the emergency treatment of elderly patients. This study examines the tolerability and pharmacokinetics of fast intravenous infusions of LEV with elderly epileptic patients. Patients and Methods Thirteen patients with a mean age of 72 years were treated with LEV IV for acute epileptic seizures or status epilepticus. 2000 mg were given within a period of 15 or 5 minutes. The LEV level was determined within 30 to 60 minutes after administration as well as 6, 12 and 24 hours later. Level of consciousness, respiration and cardiovascular functions were monitored. Results 30 to 60 minutes following administration the mean plasma level of LEV was 48 mg/L; after 6, 12 and 24 hours 31, 20 and 17 mg/L, respectively. Eight out of the thirteen patients showed a cessation of ictal activity among which five were definitely responders to LEV. Alterations in the level of consciousness, respiration and cardiovascular functions did not Occur. Conclusion 2000 mg LEV IV can be given to elderly and multimorbid patients within a period of 5 - 15 minutes without experiencing major adverse events. With this infusion rate plasma concentrations are > 40 mg/L immediately after infusion and 24 hours later > 10 mg/L. For half of the patients with status epilepticus LEV was an effective antiepileptic drug.