Acute Liver Injury during Co-treatment with Levetiracetam and Temozolomide

Abstract

Citation ABSTRACTDrug-induced liver injury (DILI) accounts for approximately 10 percent of all cases of acute hepatitis. The patterns of acute injury include any form of hepatic injury, but the most common problems are cholestasis, hepatocellular damage, or a mixed type. DILI is often reversible, and discontinuation of the offending agent usually results in a complete recovery; however, some cases may lead to chronic liver injury, cirrhosis, and even death. Temozolomide (TMZ) is an alkylating, anti-neoplastic agent used for the treatment of refractory anaplastic astrocytoma, newly-diagnosed Glioblastoma multiforme (GBM) and metastatic melanoma. Levetiracetam (LEV) is an established second-generation antiepileptic drug and is most commonly approved as adjunctive treatment of partial-onset seizures with or without secondary generalization. When administered separately each of these drugs is considered to be relatively safe and only few cases of severe liver injury can be found throughout the literature; however, LEV and TMZ are commonly used together in the treatment of brain malignancies. We report three patients who presented with jaundice during treatment with TMZ and LEV, and propose a mechanism for liver sensitization by LEV for TMZ-induced injury.

Evaluating the bioequivalence of levetiracetam brand and generic oral tablets available in the Saudi market in vivo

“…These side effect could possibly increase or decreased with the use of generic forms of LEV. Although not previously known as a cause increasing hepatic enzymes, several recent case studies have reported elevation in liver enzymes associated with the utilization of LEV either as a monotherapy or in combination with other medications such as temozolomide or Lacosamid ( Broli et al, 2010 , Chen et al, 2015 , Gutiérrez-Grobe et al, 2013 ).…”