levetiracetam and Delirium

The objective of this study was to identify the incidence of levetiracetam-associated BAEs in NCC patients.. Single-center retrospective cohort analysis.. Patient charts.. 965 adult ICU patients with a neurological injury receiving levetiracetam that were admitted to an intensive care unit.. There were 965 patients included; 52% males with a median GCS of 13. Injury types included TBI (43.1%), ICH (21.8%), SAH (20.5%), and CI (14.6%). BAEs were identified in 46% of patients. Of these, 60% had documentation of agitation/restlessness, delirium, or anxiety while receiving levetiracetam, only 25% had a positive CAM-ICU, 13% had restraints ordered, and 42% received antipsychotics. Patients with TBI had the highest incidence of BAEs (52.4%). The median time to initiation of levetiracetam after hospital admission was 6.4 hours and BAEs occurred after 1.3 days of levetiracetam initiation.. In this study, we found that almost half of our NCC population experienced levetiracetam associated BAEs which were mostly hyperactive in nature. We believe that the incidence of BAEs in our specific patient population cannot solely be attributed to ICU delirium given the lower risk of developing hyperactive delirium in ICU patients as compared to other subtypes. Therefore, monitoring and determination of the benefit versus risk in those experiencing BAEs is highly encouraged.

Topics: Adult; Antipsychotic Agents; Critical Care; Delirium; Female; Humans; Intensive Care Units; Levetiracetam; Male; Retrospective Studies

Levetiracetam (LEV) is an antiepileptic drug used widely in patients with a favorable safety profile. Studies evaluating the safety and efficacy of intravenous (IV) LEV included volumes of at least 100 mL. Minimally diluted doses administered over 5-6 min were found to be both safe and effective. Given the complexities of admixing, this practice can be impractical and result in delays in antiepileptic therapy. This study aimed to retrospectively review the safety and tolerability of rapid administration of undiluted LEV doses ≤ 1000 mg.. This was a retrospective study evaluating adverse drug reactions associated with undiluted LEV from January 1, 2018-June 1, 2018. Patients were included if they received at least one dose of undiluted LEV and were ≥ 18 years old. Safety endpoints were reviewed and collected from the time administration until hospital discharge. Endpoints included injection site pain and discomfort, injection site erythema, extravasation, IV line replacement, and any documented adverse effect leading to IV LEV discontinuation. Descriptive statistics were used to analyze the data.. A total of 199 patients were included in the study totaling 1626 doses of LEV. Most patients were administered LEV 1000 mg (60.8%), through a peripheral line (64.3%), and were prescribed LEV for seizure prophylaxis (58.3%). Patients received a mean of 8.1 ± 8 doses for a mean duration of therapy of 5 ± 4.5 days. About 98.5% of patients did not experience an adverse effect, whereas 1.5% of patients experienced agitation, delirium, confusion, and/or lethargy, which is well known to LEV therapy.. Rapid administration of undiluted LEV doses ≤ 1000 mg were well tolerated with no concentration-related side effects. Further prospective research is needed to confirm this observation as well as the safety of higher doses.

Topics: Adult; Aged; Anticonvulsants; Confusion; Delirium; Female; Humans; Injection Site Reaction; Injections, Intravenous; Levetiracetam; Male; Middle Aged; Retrospective Studies; Seizures; Solutions; Time-to-Treatment

Delirium related to levetiracetam has not been previously described in the literature and is infrequently associated with amiodarone.. The aim of this report was to discuss the possibility that administration of levetiracetam and amiodarone may precipitate delirium in some elderly patients.. An 80-year-old white woman with levothyroxine-treated hypothyroidism developed acute confusion and paranoia 5 days after substituting levetiracetam 1000 mg orally twice daily for phenytoin 100 mg orally twice daily to control new, generalized seizures. Before starting levetiracetam treatment, results of the patient's blood and urine tests, brain magnetic resonance imaging, and cerebrospinal fluid examination were within normal limits. Delirium from levetiracetam was suspected. Therefore, the dosage was titrated downward to allow discontinuation of the drug; levetiracetam was replaced with pregabalin 150 mg twice daily. Subsequent improvement in mental status occurred within 14 days after administration of the last dose of levetiracetam. Three months later, the patient developed symptomatic atrial fibrillation, which was treated with cardioversion, followed by oral amiodarone 400 mg twice daily for 10 days and then 200 mg once daily for 3 months. Within 1 to 2 weeks after starting amiodarone, she developed changes in cognition consistent with delirium. Computed tomography of the brain showed no acute changes, and blood test results were within normal limits with the exception of a serum free thyroxine level of 2.06 ng/dL and a suppressed but measurable serum thyroid-stimulating hormone level (0.13 microIU/mL). No improvement was noted after reduction of the dose of levothyroxine from 0.1 mg to 0.075 mg daily. Two weeks after amiodarone was discontinued, her mental status had returned to baseline levels. Based on a score of 6 (probable) for each medication using the Naranjo scale, the 2 episodes of delirium were probably related to levetiracetam and amiodarone.. This case report describes separate episodes of delirium probably related to treatment with levetiracetam and amiodarone in an elderly patient.

Topics: Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Anticonvulsants; Delirium; Dose-Response Relationship, Drug; Drug Interactions; Female; Humans; Levetiracetam; Piracetam