Asymptomatic elevation of liver enzymes due to levetiracetam: a case report

Abstract

Levetiracetam is a commonly used broad-spectrum anticonvulsant efficacious in both partial and generalized seizures. It has an extremely favorable side effect profile with few drug-drug interactions, low potential for hematological and hepatic toxicity, and thus has rapidly become the preferred drug in patients with traumatic brain injuries who need seizure prophylaxis. We report, here, a patient who was started on levetiracetam for seizure prophylaxis after developing large bifrontal-parietal traumatic subdural hematomas (SDH) following a fall from a horse necessitating bifrontal craniotomies for evacuation. The patient developed an asymptomatic elevation of the liver enzymes. The liver enzymes trended back to normal after levetiracetam was stopped, and topiramate was initiated in its place.

A randomized controlled trial on comparison of phenobarbitone and levetiracetam for the treatment of neonatal seizures: pilot study

“…20 Occasional reports of reversible thrombocytopenia and possible liver failure and anaphylactic shock because of levetiracetam have also been reported. [27][28][29] Though levetiracetam has predominantly renal excretion, like us, other studies has also not reported derangements in renal parameters with its use. Boylan GB et al had reported that only about 35% neonates with electrical seizures display clinical seizures.…”

“…Our previous study had demonstrated that phenobarbitone is superior to phenytoin as well 28 . However, more trials, with larger sample size are required.…”

Biochemical and histological study on the effect of levetiracetam on the liver and kidney of pregnant albino rats

“…Some authors reported an elevation of the liver enzymes in a patient following levetiracetam administration for seizure prophylaxis. The enzymes returned to the normal level after levetiracetam discontinuation [27].…”

“…Oral absorption of levetiracetam is rapid and nearly complete, with peak plasma concentrations in 1.3 h. Two-thirds of the drug is excreted unchanged in the urine and the remainder as 2-pyrrolidone-N-butyric acid (inactive deaminated metabolite). There is no metabolism of levetiracetam in the liver as its metabolism takes place in the blood [27].…”

Effect of Levetiracetam Monotherapy on Hematological Parameters in Children with Idiopathic Epilepsy

“…The coagulation profile impairment may be a presentation of liver function impairment as ob-served in Bauer et al, [28] study, who documented in their study the elevation of gamma glutamyl transferase (GGT) in 5.3% of 505 studied patients secondary to levetiracetam therapy. Another study was done by Sethi et al, [29] reported a case of asymptomatic elevation of liver enzymes due to levetiracetam. The liver enzymes returned back to normal after levetiracetam stoppage.…”