Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
J Pain Palliat Care Pharmacother. 2024 Jun;38(2):138-142. doi: 10.1080/15360288.2024.2311379. Epub 2024 Feb 12.
We present two cases, in which end-of-life patients were inadvertently treated with bolus infusions of undiluted subcutaneous levetiracetam. The patients were treated for three and four days respectively. In both cases, the course of treatment was uneventful. Especially, no seizures, nor local irritation was observed. Administration of undiluted subcutaneous levetiracetam as intermittent bolus infusions by hand holds alluring properties for end-of-life patients. Amongst others reducing patient discomfort, increasing freedom of movement, and accessibility to essential seizure prophylaxis by eliminating the need for a syringe driver, thereby helping accommodate many patients wish to die in their own home. However, pharmacokinetics, efficacy, and safety, including the optimum dilution and administration time of the subcutaneous preparation remains to be determined in clinically controlled trials.
我们报告了两例临终患者意外接受未稀释的皮下左乙拉西坦推注治疗的案例。这两例患者分别接受了三天和四天的治疗。在这两例中，治疗过程均未出现不良事件。特别是，未观察到癫痫发作或局部刺激。对于临终患者，通过手动间歇性推注未稀释的皮下左乙拉西坦具有吸引力。除了减轻患者不适、增加活动自由度、通过消除对注射器驱动的需求来获得基本的癫痫预防外，这有助于满足许多患者希望在家中离世的愿望。然而，药代动力学、疗效和安全性，包括皮下制剂的最佳稀释和给药时间，仍需在临床对照试验中确定。
