Nau Karen M, Divertie Gavin D, Valentino Alden K, Freeman William D
Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA.
Neurocrit Care. 2009;11(1):34-7. doi: 10.1007/s12028-009-9185-0. Epub 2009 Jan 29.
In intensive care unit (ICU) patients, seizure or status epilepticus treatment with intravenous benzodiazepines or conventional antiepileptic drugs (AEDs), such as phenytoin, may be accompanied by cardiovascular depression or hypotension. Levetiracetam (LVM) is a novel AED that does not undergo extensive liver metabolism, does not require drug level monitoring, and is not associated with hemodynamic instability. We retrospectively analyzed the use, safety, and efficacy of LVM in ICU patients.
Collected data included age, sex, therapy indication and duration, dosing regimen, documented seizure activity, ICU admission diagnoses, length of ICU stay, serum creatinine, liver function tests, adverse reactions, concomitant use of other AEDs, and drug interactions.
Fifty-one patients were identified (26 males; mean (SD) age, 58.2 (19.8) years). Most patients (65%) did not receive a loading dose; the most common loading dose was 1,500 mg (50% of 18 patients). The most common maintenance dose was 500 mg twice daily (59% of 51 patients), and average duration of therapy was 13.6 (12.7) days. Approximately 47% of patients had preexisting liver disease, and 25% had elevated serum creatinine. Twenty-two patients received LVM therapy for seizure prophylaxis; 29 for acute seizure treatment. Ninety-three percent of patients treated with LVM for acute seizure had no subsequent seizures; the remaining patients (7%) required additional AEDs. One patient receiving LVM for seizure prophylaxis had documented seizures requiring additional AEDs. No adverse hemodynamic events or cardiac arrhythmias were reported.
LVM appears to be safe for ICU patients when dosing is adjusted for renal function.
在重症监护病房(ICU)患者中,使用静脉注射苯二氮卓类药物或传统抗癫痫药物(AEDs)如苯妥英钠治疗癫痫发作或癫痫持续状态时,可能会伴有心血管抑制或低血压。左乙拉西坦(LVM)是一种新型抗癫痫药物,它不经过广泛的肝脏代谢,不需要进行药物浓度监测,并且与血流动力学不稳定无关。我们回顾性分析了LVM在ICU患者中的使用情况、安全性和有效性。
收集的数据包括年龄、性别、治疗指征和持续时间、给药方案、记录的癫痫发作活动、ICU入院诊断、ICU住院时间、血清肌酐、肝功能检查、不良反应、其他抗癫痫药物的联合使用情况以及药物相互作用。
共纳入51例患者(26例男性;平均(标准差)年龄为58.2(19.8)岁)。大多数患者(65%)未接受负荷剂量;最常见的负荷剂量为1500mg(18例患者中的50%)。最常见的维持剂量为每日两次500mg(51例患者中的59%),平均治疗持续时间为13.6(12.7)天。约47%的患者有既往肝脏疾病,25%的患者血清肌酐升高。22例患者接受LVM治疗以预防癫痫发作;29例用于急性癫痫发作治疗。接受LVM治疗急性癫痫发作的患者中,93%随后未再发作;其余患者(7%)需要额外的抗癫痫药物。1例接受LVM预防癫痫发作的患者记录到癫痫发作,需要额外的抗癫痫药物。未报告不良血流动力学事件或心律失常。
当根据肾功能调整剂量时,LVM对ICU患者似乎是安全的。