Sterling Torian, PharmD, BCCCP, (she/her/hers)
Evening Critical Care Pharmacist
TriStar Centennial Medical Center
Nashville, Tennessee
Disclosure information not submitted.
G. Morgan Jones, BCPS, PharmD
Clinical Pharmacy Specialist - Neurocritical Care
Methodist LeBonheur Healthcare
Germantown, Tennessee, United States
Disclosure information not submitted.
Title: High-Dose Intravenous Push Lacosamide: Safety and Efficiency in Administration
Introduction: Lacosamide is an antiepileptic medication used in the management of status epilepticus. Previous retrospective analyses have demonstrated safety and efficiency in intravenous (IV) push administration at rates up to 80 mg per minute. Although evidence exists supporting the use of IV push lacosamide, previous literature has included only a small proportion of patients receiving doses above 200 mg. We aimed to provide a larger assessment of the safety and efficiency of high dose IV push lacosamide.
Methods: This was a retrospective analysis of patients admitted to a multi-hospital system who received high-dose IV push lacosamide, either 300 mg or 400 mg. The primary outcome was the rate of adverse events associated with administration, including infusion site reactions (documentation of extravasation or infusion site irritation) and hypotension [systolic blood pressure (SBP) less than 90 mmHg] or bradycardia [heart rate (HR) less than 50 beats per minute (bpm)] within 2 hours of administration. Secondary outcomes included the incidence of PR interval prolongation (greater than 200 milliseconds) after administration and administration efficiency (time from order verification to administration).
Results: A random selection of 113 patients from 2017 to 2020 were included in the analysis. The sample primarily consisted of 57 (50.4%) intensive care unit and 29 (25.7%) emergency department patients with 97 (85.8%) patients receiving lacosamide 400 mg IV push. Baseline vitals included a mean SBP of 136 + 25.3 mmHg and median HR of 89 (72-101) bpm. The primary outcome consisted of 7 (6.2%) infusion reactions, 12 (10.6%) hypotensive events, and no reports of bradycardia. Of the 12 hypotensive events, 7 (58.3%) of these patients were treated with norepinephrine. PR interval prolongation was only documented in 2 (1.8%) patients. The mean time from order verification to administration was 41 minutes with 107 (94.7%) of the orders consisting of STAT priority.
Conclusions: IV push administration of lacosamide 300 mg and 400 mg was associated with minimal adverse events and a relatively fast time from order verification to administration. The utilization of this route of administration has potential to reduce a patient’s time in status epilepticus without adding an increased risk of adverse events.