Levetiracetam associated acute hepatic failure requiring liver transplantation: case report

Selvaraj, Vithyalakshmi; Madabushi, Jayakrishna; Gunasekar, Palanikumar; Singh, Sanjay

doi:10.1007/s00415-015-8011-1

Cited by 9 publications

(10 citation statements)

References 7 publications

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“…Recently, serious cases of DILI possibly associated with LEV have been reported. [41618] Khoury et al discussed one case in which a patient who received a combination therapy of LEV and temozolomide died due to acute fulminant liver failure. [16] Selvaraj et al reported another case in which the patient demonstrated liver enzyme elevation 8 weeks after LEV initiation.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, laboratory work showed an AST of 4800 IU/L, an AST in the range of 7000 IU/L, and a total bilirubin value of 20.4 mg/dl, and finally, liver transplantation was inevitable. [4] Delayed drug withdrawal can aggravate any existing injury to the liver, resulted in irreversible organ failure. In our case, frequent blood examination led us to identify the presence of liver injury immediately; we were able to stop LEV administration and start salvage therapy within an appropriate time frame, avoiding fulminant liver failure.…”

Section: Discussionmentioning

confidence: 99%

“…Among them, levetiracetam (LEV) is one of the newest drugs available, demonstrating certain pharmacological characteristics such as a low protein-binding property, reduced drug–drug interaction, and minimal hepatic metabolism. [34]…”

Section: Introductionmentioning

confidence: 99%

“…[89] Because LEV is predominantly not metabolized in the liver, it is recognized as a safe and reliable drug, and liver injury, including transient asymptomatic liver enzyme elevation, has been reported in <1% of patients following LEV administration. [4]…”

Section: Introductionmentioning

confidence: 99%

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A rare case of drug-induced liver injury caused by levetiracetam

Kawaguchi

Tominaga²

2019

Asian J Neurosurg

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Levetiracetam (LEV) is one of the newest antiepileptic drugs available on the market and is frequently used in neurosurgical patients requiring antiepileptic assistance. LEV is mainly excreted by the kidney with minimal hepatic metabolism, so it is considered to have a low liver toxicity. Drug-induced liver injury (DILI) associated with LEV administration is extremely rare, with only eight reported cases. In this report, we describe the case of a 44-year-old man who was admitted because of generalized convulsion, and LEV administration at a dose of 3000 mg/day was started following a diagnosis of status epilepticus. Laboratory values before LEV administration were as follows: alanine aminotransferase (ALT), 17 IU/L; aspartate transaminase (AST), 41 IU/L; and total bilirubin, 0.59 mg/dL. Viral serology tests for hepatitis B and hepatitis C yielded negative results. Several hours after LEV administration, the patient developed high-grade fever and his liver enzyme levels were found to be elevated. LEV administration was stopped immediately; the peak laboratory values were as follows: ALT, 1,192 IU/L; AST, 3,150 IU/L; and total bilirubin, 2.02 mg/dL. After conservative treatment, the patient's laboratory values were normalized. A drug-induced lymphocyte stimulation test (DLST) was performed and showed a positive response, indicating that the administration of LEV was responsible for DILI in this patient. Clearly, LEV can provoke DILI despite its low liver metabolism profile. Therefore, readministration of the drug should be avoided in such cases. An in vitro examination, such as a DLST, can be useful for ensuring a definitive diagnosis of DILI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A rare case of drug-induced liver injury caused by levetiracetam

Kawaguchi

Tominaga²

2019

Asian J Neurosurg

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“…Sixty-six percent of the administered dose is excreted unchanged in the urine; 24% is metabolized to an inactive metabolite that is detectable in the blood and is also excreted in the urine [5] . Elevated liver enzymes are reported in < 1% of patients following treatment with LEV [6] . Because of its low potential for drug-drug interactions, LEV is also considered beneficial in patients with seizures undergoing liver transplantation [7] , [8] or patients with chronic liver diseases and epilepsy [9] .…”

Section: Introductionmentioning

confidence: 99%

Severe drug-induced liver injury caused by levetiracetam – A case report and review of the literature

Rogalewski

Zuhorn

Wilkens

et al. 2021

Epilepsy & Behavior Reports

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Highlights DILI is an adverse reaction with incidence in general between 1 in 1000 and 1 in 100,000. We report DILI two months after initiation of LEV therapy without possible triggering factors. Problably idiosyncratic DILI with onset several days to months after initiation of LEV therapy. Higher incidence of DILI due to LEV in women (female:male 1.5:1). Discontinuation of LEV as first therapeutic measure; immunosuppression with cortisone for serious cases.

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Levetiracetam

2016

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Levetiracetam associated acute hepatic failure requiring liver transplantation: case report

Cited by 9 publications

References 7 publications

A rare case of drug-induced liver injury caused by levetiracetam

A rare case of drug-induced liver injury caused by levetiracetam

Severe drug-induced liver injury caused by levetiracetam – A case report and review of the literature

Levetiracetam

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