Antiepileptic Drugs in Critically Ill Patients

Salia Farrokh; Pouya Tahsili-Fahadan; Eva K. Ritzl; John J. Lewin III; Marek A. Mirski


Crit Care. 2018;22(153) 

In This Article


Selection of the most appropriate AED in the ICU setting can be challenging for a variety of reasons. Older AEDs such as phenytoin, valproic acid, and phenobarbital are often used by clinicians due to their familiarity with these agents, intravenous formulations, and availability of evidence in certain clinical scenarios. Despite this, adverse effects of these agents, drug-drug interactions, and the need for TDM may limit their use. Newer agents such as levetiracetam and lacosamide are gaining popularity due to their relatively safe AED profile, fewer drug-drug interactions, and lack of need for TDM. The efficacy of these agents for seizure prophylaxis and as second-line treatment for SE, however, should be further evaluated in large randomized clinical trials.