NAPLEX Question of the Week: Antiepileptic Drugs (AEDs)

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A 48 year old female is admitted to the ICU with septic shock from pneumonia. Her past medical history is significant for plaque psoriasis, hyperlipidemia, and partial onset seizures for which she takes Humira 40mg SQ every other week, atorvastatin 40mg orally daily, and levetiracetam 1000mg twice daily. The patient requires intubation and has a gastric feeding tube placed. The team is considering alternative dosage forms for our patient.

Which of the following dosage forms are available for levetiracetam? Select all that apply.

A. Intravenous solution

B. Oral solution

C. Oral tablets

D. Oral disintegrating tablets

E. Subcutaneous injection

Answers with rationale:

The correct answers are A, B, C, and D. All of these dosage forms are available for levetiracetam. Levetiracetam is used quite often as an AED due to its excellent tolerability, limited drug interactions (primarily renally excreted), and predictable PK profile compared to many older AEDs. For our patient, the intravenous solution would likely be used in order to guarantee absorption in a very critically ill patient who cannot afford any new issues such as breakthrough seizure. Once she stabilizes, a potential switch to the oral tablet or oral solution placed down the gastric tube could occur. The oral disintegrating tablet (brand name Spritam) is sometimes used in patients with difficulty swallowing primarily as an outpatient. There is no subcutaneous injection so answer E would be incorrect.

Have a great week as you make your way to graduation!

Dr. B

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.