Gabapentin-Induced Neurologic Toxicities

•         Levetiracetam injection is recommended for formulary inclusion restricted to the following patients:

•    Patients unable to take oral levetiracetam

•         Oral bioavailability is 100% and is unaffected by food or enteral nutritional products

•         Equivalent IV and oral doses result in equivalent Cmax, Cmin, and total systemic exposure

•         levetiracetam injection cost approximately 13 times more than the oral tablets

•        Status epilepticus after benzodiazepines (lorazepam) and fosphenytoin have failed

•         No randomized control trials have been completed for this indication. Only case reports are available.

•        Levetiracetam oral tablets cost $2.27 per 500 mg versus $29.15 per 500 mg injection ($58.30 for 1000 mg, and $175 for 3000 mg injection). Fosphenytoin injection cost $120.76 per 1000 mg

•         Pharmacist will contact ordering physicians to convert to oral therapy when the patient is able to take oral medications or has a functional feeding tube.