CONCLUSIONS
The available data on in vivo clearance of levetiracetam in critically ill patients undergoing CRRT does not support dose reduction in these patients. Clearance is consistently demonstrated to be similar to healthy adults with normal renal function. The current recommendation to dose as in CKD3b is likely to result in sub-therapeutic drug concentrations in a high number of patients. A lack of consensus on a therapeutic window for levetiracetam makes dosing recommendations challenging. However, given the similarities in clearance between CRRT and IHD we would recommend considering a twice daily dosing of 500 – 1,000 mg with an initial loading dose of 60mg/kg. Therapeutic drug monitoring should be used to guide dosing and identify those at risk of toxicity.