Abstracts

Rationale: Levetiracetam (LEV) is commonly used to treat seizures and status epilepticus in elderly patients. The standard rate of LEV infusion is 15 minutes in a diluted solution. Rapid administration of antiseizure medication is the mainstream in treating seizures to prevent status epilepticus and further progression to refractory status epilepticus. Recent studies have shown that rapid intravenous push (IVP) administration of undiluted LEV is safe and well-tolerated in adult patients. However, there are limited data regarding LEV IVP in elderly patients. The objective of this study is to evaluate the safety of LEV IVP in patients aged 65 years or older by examining the development of bradycardia (HR < 50 bpm or a ≥ 30% reduction in baseline HR), hypotension (SBP < 90 mm Hg or a ≥ 30% reduction in baseline SBP), and acute psychiatric or neurologic symptoms.

Methods: This retrospective observational study included patients who received at least one dose of LEV IVP in doses ranging from 500 mg to 3000 mg over 2 to 6 minutes from April 2021 to February 2022. Data included HR and SBP pre-and post-administration of LEV and the development of agitation, confusion, drowsiness, IV side reactions, or other adverse effects. Categorical variables were compared with Fisher’s exact tests and continuous variables were compared with t-tests.  One-way analysis of variance (ANOVA) was performed to test whether mean percent change in SBP and HR was different between the drug doses.

Results: A total of 118 patients aged 65 to 97 years old (mean of 76 years old) received IV LEV. Sixty-one (52.6 %) of them were males. Of note, 63 (53%) patients were 75 years old or above. Nineteen patients (16.1%) received 500 mg, six (5.1%) received 750 mg, 25 (21.2%) received 1000 mg, 42 (35.6%) received 1500 mg, 23 (19.5%) received 2000 mg, and three (2.5%) received 3000 mg of LEV. Three (2.5%) patients developed bradycardia, four (3.4%) developed hypotension, three (2.5 %) became agitated or confused, and four (3.4%) became drowsy after LEV IVP. There were no IV site reactions such as phlebitis or infiltrations. There were no dose-dependent differences between groups regarding SBP (p=0.31) or HR (p=0.35). When all doses were combined, the mean percentage change in SBP was 0.08 with 95% CI (-2.46, 2.62), and the mean percentage change in HR was -0.61 with 95% CI (-2.83, 1.62). There was no significant difference between pre-and post- SBP (one-sample t = 0.0602, p = 0.9521) and HR (one-sample t = -0.5385, p = 0.5913). In addition, there were no differences in SBP and HR associated with different doses of LEV (p=0.2404 and p=0.4358; Figure 1).

Conclusions: In agreement with prior reports in adult patients, our findings suggest that rapid administration of undiluted IVP LEV doses up to 3000 mg is well-tolerated and safe with proper monitoring in elderly patients, including those aged 75 years old or above._x000D_ _x000D_ Funding: None