Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran.
J Oncol Pharm Pract. 2023 Jun;29(4):927-933. doi: 10.1177/10781552231159056. Epub 2023 Feb 27.
This review aimed to summarize the available data and offer a practical recommendation regarding the optimal regimen of levetiracetam (LEV) for the prevention of busulfan-induced seizure (BIS) in patients undergoing hematopoietic stem cell transplantation (HSCT).
Published articles by searching databases (PubMed, Google Scholar, Cochrane Library, ScienceDirect) were reviewed. All types of original studies performed in pediatric and adult populations have been investigated and required data was extracted.
Eleven articles were eligible to be included in this review. A loading dose was not used in any of the studies. LEV had been started from 6 to 48 h before busulfan (Bu) initiation and continued up to 24 to 48 h after its termination. The dose range of LEV was 10 to 20 mg/kg/day divided every 12 h in pediatrics and 500 to 1000 mg twice daily in adults. Both oral and intravenous (IV) routes of administration were used. Except for three studies, no seizure had occurred in patients who had received LEV.
Considering the available evidence, LEV with the dose range from 500 to 1000 mg twice daily in adults and 10 mg/kg twice daily (20 mg/kg/day in 2 divided doses) in children orally or IV started from 6 to 24 h before Bu initiation up to 24 to 48 h after the last dose of Bu seems to prevent BIS appropriately. More prospective clinical trials with a larger population are needed to validate the optimal dosing of LEV for BIS prophylaxis in patients undergoing HSCT.
本综述旨在总结现有数据，并就预防接受造血干细胞移植（HSCT）的患者接受白消安（Bu）诱导的癫痫发作（BIS）的左乙拉西坦（LEV）最佳治疗方案提供实用建议。
通过搜索数据库（PubMed、Google Scholar、Cochrane Library、ScienceDirect）查阅发表的文章。研究人员调查了所有类型在儿科和成人人群中进行的原始研究，并提取了所需数据。
共有 11 篇文章符合纳入本综述的标准。所有研究均未使用负荷剂量。LEV 在开始使用 Bu 前 6 至 48 小时开始给药，并在 Bu 结束后 24 至 48 小时持续使用。LEV 的剂量范围为儿科 10 至 20mg/kg/天，每 12 小时分服；成人 500 至 1000mg，每日两次。两种给药途径（口服和静脉注射）都有使用。除了三项研究外，接受 LEV 治疗的患者均未发生癫痫发作。
根据现有证据，成人每日两次口服 500 至 1000mg，或儿童每日两次口服或静脉注射 10mg/kg（2 次剂量，每次 20mg/kg），在开始使用 Bu 前 6 至 24 小时开始给药，在 Bu 最后一剂后 24 至 48 小时持续给药，似乎可以适当预防 BIS。需要更多具有更大人群的前瞻性临床试验来验证 HSCT 患者预防 BIS 的 LEV 最佳剂量。
