Rationale:
Most patient with epilepsy are on oral Anti-Epileptic Drugs (AEDs). About 20-65% of epilepsy patients are on polytherapy with more than one AED. These patients present a challenge when they are unable to take their medications orally in hospital settings which necessitates the temporary use of Intravenous (IV) AED formulations. As such there are only a few conversion charts or guides for AEDs however they are not universally acceptable owing to the differences in availability of the IV medications in the formulary at different institutions. Delay or incorrect implementation of an alternate AED plan places patients at risk for having breakthrough seizures. One such delay reported through our ‘safety event reporting’ systems (SERS) highlighted a need to develop a guide for conversion of Oral AEDs to IV for patient safety as missing AEDs can lead to significant morbidity and increased length of stay.
Method:
A multidisciplinary team was constituted including Epilepsy fellows, Pediatric and adult Epileptologists, Pediatric and adult pharmacists. We identified all the FDA approved AEDs listed in American Epilepsy society guidelines. We then used available literature in Pubmed and Lexicomp as well as drug manufacturer's websites to find if there is an IV formulation to the oral medication. If IV formulation is available, we calculated the conversion ratio of oral to IV using Lexicomp with final verification by pharmacist experienced in AEDs. If no IV formulation is available, an alternative is suggested within the same drug class with similar mechanism of action and/or based on the seizure/epilepsy type. If no IV alternative is available, Oral-disintegrating tablets (ODT) options are explored. Finally the list of IV formulation and alternatives are checked for their availability in formulary at Cleveland clinic main campus. Finally if no specific IV alternative is found, a list of broad spectrum IV AEDs are suggested to be based on the epilepsy type. The final list of Oral medications, their IV formulations and alternative IV options were listed and posted in all Epilepsy units.
Results:
We identified 27 oral AEDs listed in American Epilepsy society guidelines. Nine AEDs (33%) had IV formulations. 2/9 IV formulations were not available within Cleveland Clinic pharmacy. 25.9% (7/27) AEDs did not have any specific IV alternatives.5 broad spectrum IV AEDs were listed to be used when no-formulary replacement is found. Refer to the attached table for the full replacement guide
Conclusion:
A comprehensive guide for oral to IV conversion was created and posted in the Epilepsy inpatient units. A quality gap in patient safety was filled with this project.
Funding:
:None
FIGURES
Figure 1