Rapid administration of antiseizure medications: Review of safety, effectiveness, and implications for pharmacy practice

Purpose To summarize the literature characterizing the safety and efficiency of rapid administration of antiseizure medications (ASMs) and to discuss implications for current pharmacy practice. Summary For this narrative review, a literature search was conducted via PubMed using the following search terms: [drug name] and rapid infusion, [drug name] and rapid administration, and [drug name] and intravenous push. Lacosamide, levetiracetam, and valproate were considered for inclusion. Ultimately, 14, 18, and 13 articles were included for lacosamide, levetiracetam, and valproate, respectively. Six randomized controlled trials were included, with the rest consisting of cohort studies. Methodology varied across the evaluated literature with respect to the rate of administration, approach to administration (dilution and intravenous push [IVP] or intravenous piggyback [IVPB]), and inclusion of a control group. Safety was the main outcome evaluated; efficacy, efficiency, and pharmacokinetics were also reviewed. Results indicated no significant differences in outcomes between faster and slower administration rates across all ASMs. There may be a dose-dependent increase in the length of the PR interval following lacosamide administration, although its clinical significance remains uncertain. Switching from IVPB to IVP doses of levetiracetam resulted in cost savings and increased efficiency, and administration of undiluted levetiracetam may also improve efficiency without increasing rates of adverse events. Adverse events were primarily mild for all ASMs, irrespective of IVP or IVPB administration. Some serious outcomes were reported, but these were rare. Conclusion Rapid administration of IVPB lacosamide, levetiracetam, and valproate is safe, and IVP administration of levetiracetam and lacosamide can enhance efficiency.