Background: Subcutaneous levetiracetam is used in palliative patients requiring an anticonvulsant for seizures when the oral route is inappropriate and sedation unwanted. Limited information exists around levetiracetam stability during subcutaneous infusions and compatibility with co-administered drugs. Understanding how levetiracetam is being used in the adult palliative setting can inform stability and compatibility studies to ensure quality, safety and guide its use. This research is designed to understand current prescribing and administration practices and to use this information to design further pharmaceutical studies to inform patient care.

 

Aim: To investigate how levetiracetam infusions are used in the palliative care setting, to inform drug stability studies and standardise care.

 

Method: Ethics clearance was granted by the health district ethics committee. A REDcap survey was developed and sent out to collect information on subcutaneous devices, diluents, volumes and co-administered drugs used in the Australian adult palliative care setting. Data were analysed in Excel® to examine the range of levetiracetam doses administered in 24 hours and variation in prescribing and administration. Drug combinations used with levetiracetam and priority of levetiracetam binary combination for stability testing were also reported.

 

Results:  A total of 85 responses were obtained, and 79 met inclusion criteria. Levetiracetam doses ranged from 250mg to 4000mg over 24 hours, the most common diluent was sodium chloride 0.9%; and the NIKI T34 the most common device. 24/79 respondents reported using levetiracetam infusions in the community outpatient setting. (6/79) respondents reported binary drug combination use in practice.

 

Conclusion: Levetiracetam is being administered as continuous infusions in the Australian adult palliative care setting in a wide range of doses. Morphine and Hydromorphone were identified as the priority medications for testing stability and compatibility with levetiracetam. This data will inform design of stability and compatibility studies to provide information to support clinical practice and develop guidelines.