{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T19:49:59Z","timestamp":1783712999088,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,8,10]],"date-time":"2024-08-10T00:00:00Z","timestamp":1723248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Intravenous (IV) push (IVP) is an alternative administration method for levetiracetam, but evidence evaluating it compared to IV piggyback (IVPB) for loading doses in acutely seizing patients is limited, particularly in patients with status epilepticus (SE). This study aimed to compare the efficiency and safety of IVP versus IVPB levetiracetam loading doses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center sequential retrospective study conducted in adult (\u226518\u2009years) patients who received an IV levetiracetam loading dose (&gt;2000\u2009mg or\u2009\u226520\u2009mg\/kg) for acute or suspected seizure. The primary outcome was time to administration, compared between doses given as IVP versus IVPB. Secondary outcomes included rates of adverse events (AEs), rescue benzodiazepine or antiseizure medication administration, intubation, and intensive care unit (ICU) admission between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 246 patients were included; 116 received IVP and 130 received IVPB loading doses. Median age was 56\u2009years; most patients were male (62%) and White (60%) and had witnessed seizures (67%). Doses were administered for SE in 32 (27.5%) and 46 (35.4%) patients in the IVP and IVPB arms, respectively. Median time to administration was shorter in the IVP group (12 vs. 38\u2009min, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Bradycardia (1.7% vs. 2.3%, <jats:italic>p<\/jats:italic>\u2009=\u2009.99), hypotension (7.8% vs. 12%, <jats:italic>p<\/jats:italic>\u2009=\u2009.30), sedation (6% vs. 12.3%, <jats:italic>p<\/jats:italic>\u2009=\u2009.09), intubation (10% vs. 8%, <jats:italic>p<\/jats:italic>\u2009=\u2009.37), ICU admission (32% vs. 39%, <jats:italic>p<\/jats:italic>\u2009=\u2009.31), and rescue medication administration (8.6% vs. 14.6% <jats:italic>p<\/jats:italic>\u2009=\u2009.10) were similar between groups. In SE patients, IVP was associated with shorter time to administration (12 vs. 44 min, <jats:italic>p<\/jats:italic>\u2009=\u2009.003) and lower odds of ICU admission after adjustment for age, dose, Status Epilepticus Severity Score, and seizure history (adjusted odds ratio = .23, 95% confidence interval = .06\u2013.81).<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>IVP reduced time to levetiracetam administration versus IVPB and was not associated with more AEs. Rescue agent use, intubation, and ICU admission were similar between arms, but IVP may reduce ICU admissions in SE patients. Prospective studies should assess the effectiveness of IVP versus IVPB.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18079","type":"journal-article","created":{"date-parts":[[2024,8,10]],"date-time":"2024-08-10T12:18:36Z","timestamp":1723292316000},"page":"2888-2896","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Efficiency and safety of high\u2010dose undiluted intravenous push levetiracetam loading doses compared to intravenous infusion in seizing patients: A retrospective cohort study"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0491-7277","authenticated-orcid":false,"given":"Madison","family":"Koons","sequence":"first","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8813-9346","authenticated-orcid":false,"given":"Jennifer","family":"Koehl","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riley","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3900-356X","authenticated-orcid":false,"given":"Eric S.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3425-7181","authenticated-orcid":false,"given":"Andrew J.","family":"Webb","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-012-9695-z"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-022-02868-y"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1905795"},{"key":"e_1_2_12_5_1","unstructured":"Keppra [Package Insert]. 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