Background and Importance Levetiracetam is a widely used antiepileptic drug. Due to its pharmacokinetic properties including low molecular weight, low volume of distribution and small protein binding, it is a highly dialyzed during haemodialysis (HD).¹ Therefore, it is difficult to preserve stable plasma levels during dialysis and patients starting with HD are often switched to other antiepileptic drugs. Information about levetiracetam concentrations in this group of patients are rarely described and show conflicting data. We describe a case report in which levetiracetam was supplemented during HD and where multiple levetiracetam levels were measured during HD sessions.

Aim and Objectives To determine whether stable levetiracetam plasma concentrations can be preserved during HD by intravenous suppletion. We report a case of a 63-year-old woman who started intermittent HD because of renal failure due to diabetic nephropathy. She was treated with levetiracetam 250 mg b.i.d. for therapy-resistant focal epilepsy. Levels <10 mg/L resulted in frequent seizures, therefore the target values in this patient were set at 10–25 mg/L.

Material and Methods HD sessions lasted 4 hours. Additional intravenous doses of levetiracetam were administered during bypass pre-HD, after 2 hours HD and post-HD (see table 1). Levetiracetam concentrations were measured 30 minutes after levetiracetam supplementation. Pre-HD samples were measured before the first supplementation dose was given.

ResultsPlasma concentrations remained most stable with suppletion doses of 500–250-250mg and did not result in seizures following HD.

Conclusion and Relevance HD showed to eliminate levetiracetam significantly. In this case report, intravenous levetiracetam suppletion during HD safely preserved stable levetiracetam plasma concentrations preventing seizures. Close monitoring of plasma concentrations is recommended to determine the appropriate supplemental dose to maintain therapeutic levels.

References and/or Acknowledgements 1. RenalDrugDatabase, Levetiracetam, accessed 21–06-2023, via: https://renaldrugdatabase.com/monographs/levetiracetam

Conflict of Interest No conflict of interest.