Journal of Veterinary Emergency and Critical Care 28(2) 2018, pp 157–162
A serious adverse event secondary to rapid
intravenous levetiracetam injection in a dog
Allison A. Biddick, DVM, MS ;LenoreM.Bacek,DVM,MS,DACVECC and
Amanda R. Taylor, DVM, DACVIM (Neurology)
Objective – To describe a serious adverse event as a result of rapid intravenous injection of undiluted levetirac-
etam in a dog.
Case Summary – An 8-year-old female spayed Chihuahua was evaluated for cluster seizures and tachypnea.
The patient was administered an intravenous dose of undiluted levetiracetam (60 mg/kg) and immediately
developed tachycardia, hyperglycemia, hypotension, and a dull mentation. The patient’s blood pressure and
mentation did not respond to intravenous ﬂuid boluses but improved immediately after administration of
epinephrine intravenously. The patient subsequently developed respiratory failure necessitating mechanical
ventilation, prior to cardiac arrest. Necropsy examination noted a pulmonary inﬂammatory cell inﬁltrate,
pulmonary edema, and interstitial pneumonia.
New or Unique Information Provided – This report documents a serious adverse event associated with
intravenous levetiracetam administration to a dog.
(J Vet Emerg Crit Care 2018; 28(2): 157–162) doi: 10.1111/vec.12693
seizure, status epilepticus, levetiracetam, anaphylaxis
CS cluster seizures
SE status epilepticus
Animals with cluster seizures (CS) and status epilepti-
cus (SE) are commonly evaluated in small animal emer-
gency practice, representing approximately 0.44% of to-
tal hospital admissions.
Seizures are the most common
manifestation of neurologic disease in the dog.
seizures, deﬁned as multiple seizure events within a 24-
hour period, and SE, deﬁned as continuous or repeated
seizure activity for more than 5 minutes without recov-
ery of consciousness, both require immediate treatment
to terminate seizure activity. Prolonged seizure activity
has many consequences including hypotension, hyper-
thermia, hypoxemia, lactic acidosis, and, in severe cases,
From the Auburn University College of Veterinary Medicine, Auburn, AL
The authors declare no conﬂict of interest.
Address correspondence and reprint requests to: Allison A. Biddick, 1220
Wire Road, Auburn, AL 36849. Email: email@example.com
Submitted February 23, 2016; Accepted June 16, 2016.
Permanent neuronal damage can oc-
cur following seizure activity lasting greater than 30 to
Intravenous anticonvulsants, in these situ-
ations, are often administered before a thorough history,
physical examination, and serum biochemical proﬁle of
the patient can be obtained. This may put the patient at
greater risk for adverse effects associated with adminis-
tration of these drugs.
is an anticonvulsant drug that is used
in both human and veterinary medicine. It has a favor-
able safety proﬁle in multiple species and is available in
generic and proprietary preparations.
mechanism of action is incompletely understood, it is
thought to involve inhibition of high voltage activated
calcium currents and a reduction of the effect of zinc on
inhibitory (GABAeric and glycinergic) receptors.
target for levetiracetam is the synaptic vesicle protein
SV2a, which is involved in neurotransmitter release.
Levetiracetam has a favorable pharmacokinetic proﬁle,
exhibiting rapid and complete absorption following oral
administration to dogs, minimal protein binding, and
few drug interactions.
Most other anticonvulsants are
highly protein-bound and undergo hepatic metabolism,
whereas levetiracetam is excreted solely by the kidneys.
This makes levetiracetam a good anticonvulsant for use
in patients with hepatic disease and in patients whose
hepatic function is unknown. The purpose of this case
Veterinary Emergency and Critical Care Society 2018