ReviewJournal of clinical pharmacology2025
The Impact of Augmented Renal Clearance on the Pharmacokinetics of Levetiracetam in Critically Ill Patients: A Literature Review.
Review in Journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Levetiracetam in critically ill patients with augmented renal clearance: a systematic review.European journal of clinical pharmacology · 2026Pooled it
- Antiepileptic drug therapy in companion animals: New perspectives on clinical pathology monitoring.Veterinary and animal science · 2026Review
- The long walk to a short half-life: the discovery of augmented renal clearance and its impact on antibiotic dosing.The Journal of antimicrobial chemotherapy · 2025Review
- Levetiracetam Dosing Optimization in Neurocritical Care Population: Neuro-ARC Study.Neurocritical care · 2025Observational
- Pharmacotherapy variability and precision medicine in neurocritical care.Frontiers in neurology · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Levetiracetam is an antiseizure medication (ASM) that has several advantages over other ASMs, such as dose-proportional pharmacokinetics, high bioavailability, and minimal drug interactions. The drug is primarily eliminated through the kidneys. Therefore, dose adjustments are necessary in patients with renal impairment or patients experiencing augmented renal clearance (ARC) to maintain optimal efficacy and safety. The objective of this review was to explore the existing literature on the influence of ARC on the pharmacokinetics of levetiracetam in critically ill patients. Database searched included MEDLINE, Embase, Scopus, Cochrane Library, and CINAHL. Thirteen articles were included. The prevalence of ARC ranged from 30% to 90%. All studies demonstrated the inadequacy of the levetiracetam starting dose of 500 mg twice daily (BID) in critically ill patients. Studies consistently reported altered pharmacokinetics of levetiracetam in patients with ARC, showing an elevated clearance that can reach up to 6.5L/h (∼3.8 L/h in healthy individuals). Additionally, patients with ARC had a lower area under the concentration-time curve, shorter half-life, and lower trough concentrations than those without ARC. Dosing simulations indicated that the use of at least 1500 mg BID is recommended for ARC patients to achieve similar exposures to those with no ARC on the 1000 mg BID starting dose. In conclusion, ARC significantly enhances the renal elimination of levetiracetam, elevating the risk of sub-therapeutic drug levels and treatment failure. An initial dosage regimen of 1500 mg BID would be recommended for patients exhibiting ARC. Therefore, careful monitoring of creatinine clearance and dosing optimization for patients experiencing ARC is essential.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.