Levetiracetam Pharmacokinetics During Continuous Venovenous Hemofiltration and Acute Liver Dysfunction

Neurocritical Care
Andrea M NewErin Frazee

Abstract

Levetiracetam clearance is dependent on renal (major) and hepatic (minor) elimination pathways. In the setting of organ dysfunction, dose reductions are recommended to prevent accumulation. Continuous venovenous hemofiltration (CVVH) has been shown to eliminate levetiracetam, but the preferred dosing regimen when a patient is on CVVH and has concomitant acute liver dysfunction is unknown. The objective of this case is to describe levetiracetam dosing and pharmacokinetics in the setting of CVVH and acute liver dysfunction. This is a case report of a single patient. A 59-year-old male was admitted to the intensive care unit for acute onset multiorgan dysfunction associated with a hematologic disorder. His hospital course was complicated by persistent liver dysfunction with a model for end-stage liver disease score of 47 and renal failure which necessitated initiation of CVVH. On hospital day two, the patient developed new-onset focal seizures secondary to metabolic abnormalities that resulted in the initiation of levetiracetam 1000 mg intravenously twice daily. The peak concentration at steady state was 32.2 mcg/mL, and the trough concentration was 16.1 mcg/mL (goal 12-46 mcg/mL). The volume of distribution was 0.65 L/kg, and the...Continue Reading

References

Aug 11, 2004·Clinical Pharmacokinetics·Philip N Patsalos
Apr 28, 2007·CNS Drug Reviews·Tim De SmedtPaul Boon
Nov 3, 2007·Current Opinion in Critical Care·Miet Schetz
Feb 3, 2009·Neurocritical Care·Karen M NauWilliam D Freeman
Apr 25, 2012·Neurocritical Care·Gretchen M BrophyUNKNOWN Neurocritical Care Society Status Epilepticus Guideline Writing Committee
Dec 28, 2012·The New England Journal of Medicine·Ashita Tolwani

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Citations

Sep 3, 2016·Clinical Drug Investigation·Sherif Hanafy Mahmoud
Apr 28, 2017·The American Journal of Case Reports·Edward T Van MatreTyree H Kiser
Aug 23, 2017·Neurocritical Care·Patrick M WieruszewskiErin Frazee
May 31, 2017·Journal of Clinical Pharmacy and Therapeutics·M J Company-AlbirJ L Poveda
Jul 12, 2021·Epilepsia·Weerachai ChaijamornSutthiporn Pattharachayakul

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