Is it safe to administer lacosamide and levetiracetam via IV push?

Use of undiluted lacosamide and levetiracetam to prevent seizures does not result in significant adverse events when administered via intravenous (IV) push over 5 min, according to a study. This approach appears to be a safe alternative form of administration to intermittent infusion.

A team of investigators conducted this single-centre, retrospective, observational cohort study to assess the rapid administration of undiluted lacosamide and levetiracetam in adult patients admitted from 1 September 2019 to 31 May 2020. Participants received at least one administration of IV push lacosamide at any dose or levetiracetam at doses ≤1,500 mg.

The incidence of hypotension and bradycardia served as the primary safety endpoints for the 86 patients included in this study. Of these, 36 received lacosamide and 50 levetiracetam. Based on the observation, six patients in the lacosamide group (16.6 percent) and six in the levetiracetam group (12.0 percent) had hypotension or bradycardia.

No infusion site reactions have been reported. Additionally, no incidences of a prolonged PR interval were observed among patients who were treated with lacosamide and had a 12-lead electrocardiogram.

These findings need to be confirmed in a larger prospective cohort, according to the investigators.

“Lacosamide and levetiracetam are antiseizure medications used in the treatment and prevention of seizures. Historically, these agents have been administered as slow IV infusions after further dilution,” the investigators said.