577: Safety and Tolerability of Rapid Administration of High-Loading Doses of Brivaracetam

Introduction: Brivaracetam (BRV) is a newer antiseizure medication available as an intravenous (IV) formulation. Similar to levetiracetam, BRV is a SV2A agonist, however has 10 to 30-fold higher potency for SV2A. BRV is increasingly used for treatment of status epilepticus (SE) however there is little data for loading doses >200 mg. Our center routinely administers loading doses up to 400 mg as rapid IV push. The goal of this study is to evaluate the safety and tolerability of high loading doses of BRV administered as IV push within our health system. Methods: This was a single center retrospective chart review of patients receiving BRV doses ≥250 mg as IV push. Safety endpoints included hospital location emergency department (ED), intensive care unit (ICU), or floor, impact on mean arterial pressure (MAP), heart rate (HR), use of vasopressors, and sedation parameters Richmond Agitation Sedation Scale (RASS) and Glasgow coma scale (GCS). Results: A total of 49 doses of BRV ≥250 mg were administered, with a mean dose of 377 mg. Administration locations included: ED (12%), ICU (49%), and floor (39%). SE was diagnosed in 53% of patients. The mean MAP was 89.6 mmHg prior to BRV. The mean lowest MAP within 2 hours (h) post BRV was 84.5 mmHg. MAP decreased by >15% in 16% of patients, with 6% experiencing decrease in MAP to 2 mcg/min and 1 patient was initiated on a vasopressor within 2 h post BRV. No patients experienced a change in HR to 120 beats per minute. A junctional rhythm was seen in 1 patient within 1 h post BRV when epicardial wires were manipulated. The mean baseline RASS was -2.26 prior to BRV and was -2.8 within 2 h post BRV. Based on RASS decrease by >1 point or GCS decrease by >2 points and review of notes, sedation was experienced in 17% of patients. No patient receiving BRV on the floor required ICU transfer for sedation or blood pressure management. Conclusions: Rapid administration of high loading doses of BRV was well tolerated with few occurrences of hypotension, changes in heart rate or significant sedation. Though further studies are needed, our data suggests it is also safe to administer outside of the ICU. This study adds to the literature to support the safety and tolerability of IV push BRV doses ≥250 mg.