Parenteral Manual

LevETIRAcetam

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

Alternate Name(s): 
KEPPRA
Classification: 
Anticonvulsant
Original Date: 
February 2016
Revised Date: 
March 2023
Indications: 
  • Treatment of convulsive status epilepticus
  • Short term parenteral replacement for oral levetiracetam
Reconstitution and Stability: 
  • Available as 500 mg/5 mL (100 mg/mL) clear solution -  product with particulate matter or discoloration should not be used
  • Store at room temperature
  • Single use vial - use immediately after opening and discard unused portion
  • Diluted solution in 0.9% NaCl  (40 mg/mL) stable 14 days refrigerated
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, Lactated Ringer's - stable 24 hours at room temperature

- Additive compatible: diazepam, lorazepam, valproic sodium

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES - DO NOT ADMINISTER UNDILUTED
Usual dilution: 40 mg/mL for doses greater than or equal to 200 mg

- 20 mg/mL for doses less 200 mg
Infusion time: 15 minutes.  May give over 5 minutes for status epilepticus
IV Continuous Infusion NO

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

** total daily intravenous dosage should be equivalent to the total daily dosage and frequency of the oral administration **

Pediatric:

  • Loading dose:  20 - 40 mg /kg/dose x1
    Dose limit:  60 mg/kg/dose or 3000 mg/dose
  • Initial maintenance dose: 5 - 10 mg/kg/day divided Q12H
  • May increase dose every 1 - 2 weeks to 40 - 60 mg/kg/day divided Q12H
    Dose limit:  100 mg/kg/day or 3000 mg/day, whichever is less

Adults:

  • 1000 mg/day divided Q12H (Maximum: 3000 mg/day)
  • May be diluted in 100 mL bag of D5W, 0.9%NaCl, or Lactated Ringer's and administered over 15 minutes
     

DOSAGE ADJUSTMENT in RENAL IMPAIRMENT:

  • Dosage should be reduced in patients with moderate and severe impairment - refer to available references or clinical pharmacist for dosage adjustment
Potential hazards of parenteral administration: 
  • Central nervous system: sedation, dizziness, irritability, behavioural changes, headache
  • Dermatologic: rash (some cases of Stevens-Johnson Syndrome reported)
  • Hematologic: decreased RBC, hematocrit, hemoglobin, neutrophils
Notes: 
  • Monitoring:
    Prior to administration:
    - Baseline vital signs: respiratory rate, heart rate, blood pressure
    - Renal function
    - CBC
    - Sensitivity to levetiracetam

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