Subcutaneous Infusion

Vignette:

A 76 year-old female with primary seizure disorder resides in a skilled nursing facility. She is currently receiving levetiracetam (Keppra®) 1400 mg intravenously every 12 hours. She would like to remain at the SNF but they have difficulty with intravenous medications as they don't always have a registered nurse at night. Can levetiracetam be given subcutaneously and how would it be given?

Discussion:

Levetiracetam can be given subcutaneously. The medication is mixed in 50 -100 ml of normal saline and given via gravity infusion over 1-2 hours. Once mixed, the solution is stable for 24 hours and must be given within that time. PAL-MED Connect receives numerous inquiries about which medications can safely be given subcutaneously (SC). A study in the European Journal of Radiology (2006) found that the majority of assumed intramuscular injections are actually subcutaneous. A partial list of medications that can be given SC includes atropine, ampicillin, bumetanide, ceftriaxone, clindamycin, dexamethasone, digoxin, fentanyl, fosphenytoin, furosemide, glycopyrrolate, haloperidol, hydromorphone, hyoscyamine, ketorolac, levetiracetam, lorazepam, methadone (preferably with dexamethasone for continuous infusion), methylprednisolone, metoclopramide, midazolam, morphine, octreotide, olanzepine, ondansetron, scopolamine, sodium valproate, and sufentanil.

References:

Chan, J. Colville, T. Persaud, O. Buckley, S. Hamilton, W.C. Torreggiani. Intramuscular injections into the buttocks: Are they truly intramuscular? European Journal of Radiology 58 (2006) 480–484.

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