Clinical utility of phenytoin with loading dose versus levetiracetam in hypoalbuminemic patients admitted with neurotrauma: A retrospective study at King Hussein medical center

Background and Aims: Brain-damaged patients often take phenytoin to treat seizures. Low albumin makes the medication more closely connect to proteins, changing its effect. It may become more hazardous. Levetiracetam may be better for low albumin levels and neurotrauma since it doesn't cling to proteins, but there isn't much research on it. The test determines if phenytoin (with a loading dosage) aids brain injury survivors with low albumin levels safely and efficiently.
Methods: This research examined 412 neurotrauma patients hospitalised at Jordan's King Hussein Medical Centre between February 2023 and January 2025 with albumin levels below 3.5 g/dL. These patients received phenytoin (15–20 mg/kg initial dosage + maintenance dose) or levetiracetam (500–1000 mg twice a day). The major objectives were to determine the 7-day seizure rate and adverse medication responses. The secondary outcomes were death and hospital stay. Statisticians employed ANCOVA and multivariable logistic regression.  Results: 12.4% of phenytoin users experienced seizures, compared to 9.8% of levetiracetam users (*p*=0.21). ADRs: phenytoin (23.5%) vs. levetiracetam (8.3%; p<0.001), including liver damage (15.9% vs. 0%) and nerve/brain damage (2.9% vs. 0%). People with severe hypoalbuminemia (<2.5 g/dL) had greater adverse drug reactions (ADRs) with phenytoin (32.1% vs. 18.9%; p=0.02). Death rates and ICU stays were similar across groups (*p*>0.05), although ADRs prolonged stays by 2.5 days (*p*=0.03).
Conclusion: Levetiracetam functioned as well as phenytoin for hypoalbuminemic neurotrauma, particularly severe hypoalbuminemia. It also reduced harmful medication responses. These findings suggest this high-risk group should take levetiracetam more.