Intranasal Levetiracetam for Seizures in Dogs

In the Literature

Wagner JL, Foss KD, Reinhart JM, Forsythe LE. Single-dose pharmacokinetics of intranasal levetiracetam in healthy dogs. J Vet Pharmacol Ther. 2026;49(2):110-119. doi:10.1111/jvp.70046

The Research …

Epilepsy is the most common chronic neurologic disorder in dogs.¹ Approximately 20% to 40% of dogs with epilepsy have inadequate seizure control and may also experience status epilepticus and/or cluster seizures.² IV administration of antiseizure medications, specifically benzodiazepines, is the current mainstay treatment; however, IV access is not an option in some cases.³ Intranasal delivery of antiseizure medications is an acceptable alternative for emergency antiseizure medication administration.

A mucosal atomization device is a small attachment placed on the end of a syringe that turns liquid medication into a fine mist for delivery across mucous membranes.⁴ Intranasal benzodiazepines have been shown to quickly reach serum concentrations associated with seizure control.² Levetiracetam is a frequently prescribed antiseizure medication for dogs experiencing epileptic seizures and is readily available in oral and IV forms. Levetiracetam has an exceptional safety profile and can be rapidly absorbed systemically when delivered intranasally in mice.⁵

This 2-way, randomized, crossover study evaluated use of a mucosal atomization device to deliver a concentrated solution of levetiracetam intranasally to healthy dogs to determine whether appropriate serum concentrations can be reached for seizure control. If successful, this method may offer another option for emergency seizure control.

Healthy, client-owned dogs (n = 9) were randomly assigned to receive either a 30 mg/kg intranasal (460 mg/mL compounded) or a 30 mg/kg IV (100 mg/mL commercial) levetiracetam dose. The commercial solution would yield volumes too large for intranasal administration. After a washout period of at least 7 days, based on the half-life of levetiracetam (2-4 hours after IV administration; 2.8-3.6 hours after intranasal administration⁶), levetiracetam was administered to each dog by the opposite route of the previous administration.

Following intranasal administration, a single dose of levetiracetam was absorbed and maintained serum concentration above the minimum target for several hours. The minimum target was set at 5 micrograms/mL, which is the low end of the generally accepted reference interval in human medicine (5-45 micrograms/mL).⁷ A reference interval for dogs has not been established.⁸

Although intranasal administration of levetiracetam in healthy dogs rapidly achieved the minimum target reference concentration and maintained therapeutic concentrations for several hours, this concentration may not be effective for emergency seizure control in dogs, and multiple doses may be needed. Further testing and studies are needed.

… The Takeaways

Key pearls to put into practice:

• Intranasal administration of levetiracetam can be considered in emergent seizure cases when IV access cannot be obtained or benzodiazepines are not available. A concentrated levetiracetam solution should be available in these cases.

• Evidence supporting administration of diazepam (intranasal or rectal) and midazolam (intranasal) for emergency seizures is stronger than for intranasal levetiracetam.^4,9 Benzodiazepines have a rapid onset of action and proven efficacy for management of status epilepticus and cluster seizures; however, the duration of action is short, and additional antiseizure medications (eg, levetiracetam) may be needed. Levetiracetam administered intranasally may be a reasonable addition to treatment, particularly for at-home administration.

• Levetiracetam is simple to administer intranasally and may be useful in cases in which owners cannot or are unwilling to administer rectal medications. Adverse effects are mild and include sneezing after administration.

• The intranasal dose may be split and administered in each nostril.