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VOLUME 14 , ISSUE 3 ( May-June, 2022 ) > List of Articles

RESEARCH ARTICLE

A Randomized Parallel Non-inferiority Trial to Evaluate the Safety and Efficacy of Levetiracetam in Comparison to Magnesium Sulfate in the Management of Severe Preeclampsia

Rajasri G Yaliwal, Aruna M Biradar, Sangamesh B Bhagavati, Shreedevi S Kori, Subhashchandra R Mudanur

Keywords : Anticonvulsants, Levetiracetam, Magnesium Sulfate, Preeclampsia, Seizure

Citation Information : Yaliwal RG, Biradar AM, Bhagavati SB, Kori SS, Mudanur SR. A Randomized Parallel Non-inferiority Trial to Evaluate the Safety and Efficacy of Levetiracetam in Comparison to Magnesium Sulfate in the Management of Severe Preeclampsia. J South Asian Feder Obs Gynae 2022; 14 (3):287-291.

DOI: 10.5005/jp-journals-10006-2046

License: CC BY-NC 4.0

Published Online: 27-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: The study aimed to compare the safety and efficacy of levetiracetam to magnesium sulfate for the prevention of convulsions in preeclampsia. Materials and methods: A total of 60 women with preeclampsia with severe features were randomized to receive either levetiracetam or magnesium sulfate. In the levetiracetam group, a loading dose of 1000 mg/day (500 mg 12th hourly for 24 hours) was administered slowly over 5 minutes intravenously followed by an oral tablet of levetiracetam 500 mg 12th hourly for 5 days. In the magnesium sulfate group, 4 gm of magnesium sulfate was given IV over 3–5 minutes followed by a maintenance dose of 1 gm/hour for 24 hours. Magnesium sulfate solution was given in dilution via infusion pump. Results: This study shows that levetiracetam is non-inferior to magnesium sulfate as none of the patients in both arms had any convulsions. Conclusion: Levetiracetam is non-inferior to magnesium sulfate in the prevention of convulsions in preeclampsia. It can be used as an alternative to magnesium sulfate, especially when magnesium sulfate is contraindicated.

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  1. Handa S, Pujar Y. Evaluation of uterine artery Doppler at 11–13+6 weeks of gestation for prediction of preeclampsia: a descriptive observational study. J South Asian Feder Obstet Gynaecol 2019;11(5):305–308. DOI: 10.5005/jp-journals-10006-1721.
  2. Rajesh A, Suresh A, Muralidharan V. Serum lipid profile in second trimester as a predictor of gestational hypertension. J South Asian Feder Obstet Gynaecol 2020;12(1):23–26. DOI: 10.5005/jp-journals-10006-1750.
  3. Bhattacharjee N, Saha SP, Ganguly RP, et al. A randomised comparative study between low-dose intravenous magnesium sulphate and standard intramuscular regimen for treatment of eclampsia. Journal of Obstetrics and Gynaecology 2011;31(4):298–303. DOI: 10.3109/01443615.2010.549972.
  4. Gestational hypertension and preeclampsia: ACOG practice bulletin, Number 222. Obstet Gynecol 2020;135(6):e237–e260. DOI: 10.1097/AOG.0000000000003891.
  5. Keepanasseril A, Maurya DK, Manikandan K, et al. Prophylactic magnesium sulphate in prevention of eclampsia in women with severe preeclampsia: randomised controlled trial (PIPES trial). J Obstet Gynaecol 2018;38(3):305–309. DOI: 10.1080/01443615.2017.1351931.
  6. Khooshideh M, Ghaffarpour M, Bitarafan S. The comparison of anti-seizure and tocolytic effects of phenytoin and magnesium sulphate in the treatment of eclampsia and preeclampsia: a randomised clinical trial. Iran J Neurol 2017;16(3):125–129. PMID: 29114367.
  7. Fogleman CD. Magnesium sulfate and other anticonvulsants for women with preeclampsia. Am Fam Physician 2011;83(11):1269–1270. PMID: 21661707.
  8. Koc G, Keskin Guler S, Karadas O, et al. Fetal safety of levetiracetam use during pregnancy. Acta Neurol Belg 2018;118(3):503–508. DOI: 10.1007/s13760-018-0996.
  9. Duley L, Gülmezoglu AM, Chou D. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database Syst Rev 2010;2010(9):CD002960. DOI: 10.1002/14651858.CD002960.pub2.
  10. Duley L, Gülmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev 2003;(2):CD000025. DOI: 10.1002/14651858.CD000025 [Update in: Cochrane Database Syst Rev. 2010;(11):CD000025. PMID: 12804383].
  11. Duley L, Henderson-Smart DJ, Walker GJ, et al. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev 2010;12:CD000127. DOI: 10.1002/14651858.CD000127.pub2.
  12. Sibai BM. Magnesium sulfate prophylaxis in preeclampsia: lessons learned from recent trials. Am J Obstet Gynecol 2004;190(6): 1520–1526. DOI: 10.1016/j.ajog.2003.12.057.
  13. Weston J, Bromley R, Jackson CF, et al. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database Syst Rev 2016;11(11):CD010224. DOI: 10.1002/14651858.CD010224.pub2.
  14. De Jesus LC, Sood BG, Shankaran S, et al. Antenatal magnesium sulfate exposure and acute cardiorespiratory events in preterm infants. Am J Obstet Gynecol 2015;212(1):94.e1–94.e947. DOI: 10.1016/j.ajog.2014.07.023.
  15. Prasannan L, Blitz MJ, Rochelson BL, et al. Contraindications to Magnesium Sulfate and alternative seizure prophylaxis for severe preeclampsia [09L]. Obstet Gynecol 2020;135:126S. DOI: 10.1097/01.AOG.0000664588.58874.5a.
  16. Satia M, Shilotri M. A study of the obstetric and perinatal outcomes of eclampsia and the use of levetiracetam in its management. Int J Reprod Contracept Obstet Gynecol 2016;5(12):4266–4270. DOI: 10.18203/2320-1770.ijrcog20164325.
  17. Abraham C, Kusheleva N. Management of pre-eclampsia and eclampsia: a simulation. MedEdPORTAL 2019;15:10832. DOI: 10.15766/mep_2374-8265.10832.
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