Neonatal Drug Therapy Manual

LevETIRAcetam

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated December 7, 2020 - 2:00pm

Alternate Name(s): 
Keppra, Levetiracetam injection
Classification: 
Anticonvulsant
Original Date: 
May 2016
Revised Date: 
December 2020
Indications: 
  • Treatment of Phenobarbital resistant seizures
Administration: 
  • IV intermittent infusion: over 15 minutes
  • PO
Dosage: 
  • Loading dose: 60 mg/kg/dose IV/PO x 1
  • Maintenance dose: 10 - 60 mg/kg/day IV/PO divided Q12h

Dosage adjustment required in renal impairment.  Refer to available references or clinical pharmacist for dosage adjustment.

Side Effects: 
  • CNS: sedation, irritability
  • Dermatologic: rash (severe cases including Stevens-Johnson syndrome have been reported, drug should be discontinued with any signs of hypersensitivity)
  • Hematologic: decrease in RBC count, Hgb, leukopenia, neutropenia
  • Hepatic: rare cases of liver failure and hepatitis
Parameters to Monitor: 
  • CBC
  • Renal function
  • Liver function tests if presenting other risk factors for hepatic impairment
  • It is not necessary to perform routine drug levels
Reconstitution and Stability: 

CHEO:

  • Levetiracetam 100 mg/mL (doses < 200 mg)
    • Take 4 mL (400 mg) and add to 16 mL 0.9%NaCl
    • Final concentration : 20 mg/mL
  • Levetiracetam 100 mg/mL (doses > 200 mg)
    • Take 4 mL (400 mg) and add to 6 mL 0.9%NaCl
    • Final concentration: 40 mg/mL

TOH:

  • Levetiracetam 100 mg/mL
    • Take 4 mL (400 mg) and add to 16 mL 0.9%NaCl
    • Final concentration: 20 mg/mL
Compatibility: 

- Solutions compatible: D5W, 0.9% NaCl

Notes: 

- IV:PO conversion is 1:1

- Do not abruptly discontinue therapy.  Withdraw gradually to reduce potential for increased seizure frequency

 

References: 

- Sharpe et al. Levetiracetam versus Phenobarbital for Neonatal Seizures: A Randomized Controlled Trial. Pediatrics June 2020, 45 (6) e20193182

- Han JY, Moon CJ, Youn YA, Sung IK, Lee IG. Efficacy of levetiracetam for neonatal seizures in preterm infants. BMC Pediatr. 2018;18(1):131. Published 2018 Apr 10. doi:10.1186/s12887-018-1103-1

- Mruk AL, Garlitz KL, Leung NR.  Levetiracetam in Neonatal Seizures: A Review. J Pediatr Pharmacol Ther. 2015 Mar-Apr; 20(2): 76-89

- Slaughter et al.  Pharmacological treatment of neonatal seizures: A systematic review. J Child Neurol 2013; 28(3): 351-64

- American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: ASHP 2017

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