Subcutaneous Levetiracetam Use in Adult Palliative Care in Australia: A Cross-Sectional Survey

BACKGROUND: Levetiracetam (LEV) continuous subcutaneous (SC) infusion (CSCI) is increasingly used in Australian patients receiving palliative care; however, evidence is limited for the stability and compatibility of LEV administered alone or with other medications. Understanding current prescribing practices and clinicians' research priorities is essential for guiding clinically relevant laboratory testing to support best practice. AIMS: To examine current LEV infusion practices in Australian adult palliative care settings and identify clinician-prioritized drug combinations for future stability and compatibility testing. METHODS: A cross-sectional online survey was distributed to palliative care clinicians across Australia. LEV administration practices, including doses, infusion volumes, diluents, devices, infusion durations, and drug combinations, were assessed. Clinician-reported rankings of priority medications for binary stability and compatibility testing with LEV were summarized. RESULTS: Among 62 respondents representing each Australian state and territory (primarily doctors, nurses, and pharmacists), LEV was predominantly administered as a continuous 24-hour SC infusion. Reported total daily doses ranged from 250 to 4000 mg, with infusion volumes between 10 and 120 mL. 0.9% sodium chloride and water for injection were the only diluents used. Morphine and hydromorphone were the most frequently reported coadministered medications and ranked as the highest priorities for future stability and compatibility testing with LEV. CONCLUSION: LEV was administered via CSCI over a wide range of doses. Clinician-identified priorities for binary stability and compatibility testing were hydromorphone or morphine combinations with LEV. These findings provide a practice-informed foundation for targeted laboratory studies to support safe, efficient, and evidence-based clinical practice both in Australia and internationally.