Rhabdomyolysis associated with levetiracetam administration

Lorenzo, Rodica Di; Li, Yuebing

doi:10.1002/mus.25548

Cited by 20 publications

(17 citation statements)

References 6 publications

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“…Rhabdomyolysis has been documented as a rare adverse effect of levetiracetam, and until now, only five cases have been reported in the literature. Three of them were pediatric patients and the other two patients were in the late 20s [ 1 , 4 - 7 ]. Our patient is a 42-year-old male who received levetiracetam for seizure treatment and prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam

Rastogi

Singh

Kaur

et al. 2018

Cureus

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Levetiracetam is an anti-epileptic that works at the synapse and binds synapse vesicle protein 2A, thereby controlling the release of neurotransmitters. Its side effects mainly include somnolence, headache, fatigue, dizziness, vomiting, and behavioral alterations. Rhabdomyolysis is a rare adverse effect of levetiracetam. The underlying pathophysiology of this adverse effect is unknown. Our patient is a 42-year-old male who was brought to the hospital with a complaint of generalized tonic-clonic seizures and urinary incontinence. His symptoms were caused by hyponatremia. Levetiracetam was started for seizure prevention along with management for hyponatremia. His creatine phosphokinase levels increased on the third day of admission to 30,000 U/L. Four days after the discontinuation of levetiracetam and with the institution of supportive therapy, the patient’s rhabdomyolysis resolved.

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Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam

Rastogi

Singh

Kaur

et al. 2018

Cureus

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“…None of the levetiracetam users who developed AKI had evidence of rhabdomyolysis. Rhabdomyolysis with levetiracetam use has been documented in nine case reports in the literature ( Supplemental Table 11), within 2 weeks of drug initiation, and with a higher prevalence reported in Japanese patients (7,13,(36)(37)(38)(39)(40)(41)(42). Although prolonged seizures can independently cause rhabdomyolysis, two case reports of AKI have been attributed to rhabdomyolysis secondary to levetiracetam use (7,13).…”

Section: Discussionmentioning

confidence: 99%

Population-Based Study of Risk of AKI with Levetiracetam

Yau

Burneo

Jandoc

et al. 2018

CJASN

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Background and objectives Regulatory agencies warn about the risk of AKI with levetiracetam use on the basis of information from case reports. We conducted this study to determine whether new levetiracetam use versus nonuse is associated with a higher risk of AKI.Design, setting, participants, & measurements This was a population-based retrospective cohort study of adults with epilepsy in Ontario, Canada. Patients who received a new outpatient prescription for levetiracetam between January 1, 2004 and March 1, 2017 were matched to two nonusers on stage of CKD, recorded seizure in the prior 90 days, and logit of a propensity score for levetiracetam use. The primary outcome was a hospital encounter (emergency department visit or hospitalization) with AKI within 30 days of cohort entry. Secondary outcomes were AKI within 180 days and change in the concentration of serum creatinine. We assessed the primary outcome using health care diagnosis codes. We evaluated the change in the concentration of serum creatinine in a subpopulation with laboratory measurements. ResultsWe matched 3980 levetiracetam users to 7960 nonusers (mean age 55 years, 51% women). Levetiracetam use was not significantly associated with a higher risk of AKI within 30 days (13 [0.33%] events in levetiracetam users and 21 [0.26%] events in nonusers [odds ratio, 1.24; 95% confidence interval, 0.62 to 2.47]). Similarly, there was no significant association with AKI within 180 days (odds ratio, 0.70; 95% confidence interval, 0.43 to 1.13). The change in the concentration of serum creatinine did not significantly differ between levetiracetam users and nonusers. ConclusionsIn this population-based study levetiracetam use was not associated with a higher risk of AKI.

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“…But this patient had severe intellectual impairment and it is likely that milder symptoms may have been present before rhabdomyolysis was eventually detected. In all cases except one the CPK showed a downward trend within 24 hours except in the case reported by Di Lorenzo and Li where the CPK peaked at 48 hours after stopping levetiracetam before showing a tendency to improve 7. Though the downward trend of CPK and resolution of symptoms started early, CPK values took around 7–14 days to return to normal range.…”

Section: Discussionmentioning

confidence: 67%

“…Though the downward trend of CPK and resolution of symptoms started early, CPK values took around 7–14 days to return to normal range. Once again, in the case described by Di Lorenzo and Li it took 40 days for CPK to normalise 7. He did not have renal impairment and was not on any other antiepileptic.…”

Section: Discussionmentioning

confidence: 93%

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Rhabdomyolysis: a rare adverse effect of levetiracetam

Thomas¹,

Mirza

Shaikh

et al. 2019

BMJ Case Rep

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A 62-year-old previously healthy male was admitted with new onset generalised tonic-clonic seizures. Treatment was initiated with the antiepileptic levetiracetam and he had no further episodes of seizures. Creatine kinase (CPK) level was 1812 IU/L 12-hour postadmission. Despite good hydration, his CPK levels continued to rise dramatically and reached a level of 19 000 IU/L on day 5. This rise was unexplained as he did not have any further seizures and had a normal renal function. In the absence of other risk factors, the rare possibility of levetiracetam being responsible for the disproportionately high CPK was considered. Within 12 hours of withdrawal of levetiracetam, there was a downward trend in the CPK levels, with a 10-fold decrease in CPK levels over the next 4 days. This is only the ninth case reported in literature regarding this rare and potentially serious adverse effect of levetiracetam.

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Rhabdomyolysis associated with levetiracetam administration

Cited by 20 publications

References 6 publications

Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam

Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam

Population-Based Study of Risk of AKI with Levetiracetam

Rhabdomyolysis: a rare adverse effect of levetiracetam

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