Population Pharmacokinetics of Levetiracetam in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage Exhibiting Augmented Renal Clearance.

Abstract

BACKGROUND AND OBJECTIVE:

Patients with severe trauma exhibit augmented renal clearance, which can alter the dosing requirement of renally eliminated drugs. This study aimed to develop a population pharmacokinetic model for levetiracetam in patients with severe traumatic brain injury and aneurysmal subarachnoid hemorrhage, and use it to describe optimal dosing regimens.

METHODS:

This was a prospective open-label observational study. Critically ill adult patients with severe traumatic brain injury or aneurysmal subarachnoid hemorrhage without renal dysfunction and receiving levetiracetam were eligible. Serial levetiracetam plasma concentrations were analyzed to develop a population pharmacokinetic model and perform dosing simulations.

RESULTS:

A two-compartment model best described the concentration-time data from 30 patients. The mean ± standard deviation parameter estimates were bioavailability (F) of 0.8 ± 0.2, absorption rate constant of 2.4 ± 2 h-1, clearance 2.5 ± 1.1 L/h, central volume of distribution 8.9 ± 3.0 L/h, and transfer rate constraints of 1.8 ± 1.1 h-1 from central to peripheral compartments and 0.7 ± 0.3 h-1 from peripheral to central compartments. For the simulated intermittent dosing regimens, on average, the median trough concentration reduced by 50% for every 40-mL/min/1.73 m2 increase in urinary creatinine clearance. Simulated doses of at least 6 g/day were required for some levels of augmented renal clearance.

CONCLUSIONS:

Patients with severe traumatic brain injury and aneurysmal subarachnoid hemorrhage with augmented renal clearance are at risk of not achieving target levetiracetam plasma concentrations. We suggest dose titration guided by measured creatinine clearance, and/or, therapeutic drug monitoring if available, to minimize the risk of seizures.

• Authors: Fekade Bruck Sime, Jason A Roberts, Rosalind L Jeffree, Saurabh Pandey, Santosh Adiraju, Amelia Livermore, Jenie Butler, Suzanne L Parker, Steven C Wallis, Jeffrey Lipman, Menino Osbert Cotta
• Journal: Clinical pharmacokinetics (Clin Pharmacokinet) Vol. 60 Issue 5 Pg. 655-664 (05 2021) ISSN: 1179-1926 [Electronic] Switzerland
• PMID: 33428169 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Levetiracetam

Topics

• Adult
• Anti-Bacterial Agents (therapeutic use)
• Brain Injuries, Traumatic (drug therapy)
• Critical Illness
• Humans
• Levetiracetam
• Prospective Studies
• Renal Insufficiency
• Subarachnoid Hemorrhage (drug therapy)