Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report

Company-Albir, María José; Ruiz-Ramos, J.; Solana-Altabella, Antonio; Marqués-Miñana, María Remedios; Vicent, Carlos; Poveda, José Luís

doi:10.1111/jcpt.12568

Cited by 5 publications

(2 citation statements)

References 11 publications

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“…Levetiracetam is a renally metabolized ASM with low plasma‐protein binding. There have been reports of seizure risk due to a temporary decrease in serum concentrations during hemodialysis 25 . From this perspective, perampanel, which shows stable serum concentrations owing to its minimal removal by dialysis, may prove to be a stable ASM for patients undergoing hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Serum perampanel levels in patients with seizures are not affected by hemodialysis

Nakazawa,

Shiraishi,

Matsuyoshi

et al. 2024

Epilepsia Open

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Perampanel belongs to a novel class of antiseizure medications (ASMs). Studies examining the effect of hemodialysis on perampanel serum levels in clinical settings are lacking. We aimed to evaluate the changes in serum perampanel levels during hemodialysis. We studied patients with seizures who received oral perampanel between April 2020 and March 2023 and whose serum concentration of perampanel was measured before and after hemodialysis. We analyzed the serum concentrations of levetiracetam and lacosamide for comparison. Fourteen patients, with a mean age of 76.1 ± 7.88 years, were included. The dose of perampanel was 2.14 ± 1.27 mg. The hemodialysis clearance rate of perampanel, levetiracetam, and lacosamide was 0 ± 13%, 69 ± 11%, and 59.6 ± 8.2%, respectively. The post‐dialysis CD ratio decreased significantly with levetiracetam but not with perampanel. Adverse but acceptable effects of perampanel were observed in two patients. The serum concentrations of several ASMs have been shown to be reduced during hemodialysis. Our study revealed that the serum perampanel concentration does not decrease during hemodialysis. Owing to the low rate of adverse effects and the stability of perampanel serum concentration during hemodialysis, perampanel could be a favorable choice as an ASM for patients with seizures undergoing hemodialysis.Plain Language summaryOur study looked at how hemodialysis affects the serum levels of perampanel, a new type of medication for seizures. In 14 patients who started treatment between April 2020 and March 2023, perampanel serum levels did not decrease during hemodialysis, unlike other seizure medications. This shows that perampanel can be a good option for patients with seizures who need hemodialysis, with fewer side effects compared to other medications.

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Section: Discussionmentioning

confidence: 99%

Serum perampanel levels in patients with seizures are not affected by hemodialysis

Nakazawa,

Shiraishi,

Matsuyoshi

et al. 2024

Epilepsia Open

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“…Regarding LEV pharmacokinetics among patients undergoing intermittent hemodialysis, the volume distribution of LEV and the intradialytic elimination half-life are reported to be 0.48 L/kg and 31 h, respectively. HD removes nearly 85% of serum LEV ( 23 ), and the potential risk of underdosing of LEV in HD patients has been reported ( 24 , 25 ). We suspect that the accumulation of LEV itself did not contribute to the development of DIHS/DRESS in our case.…”

Section: Discussionmentioning

confidence: 99%

Atypical, Levetiracetam-induced Hypersensitivity Syndrome Complicated by Fulminant Liver Failure in a Patient Undergoing Hemodialysis

et al. 2022

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A 59-year-old man undergoing hemodialysis was administered levetiracetam, after which he developed a systemic rash, high fever, severe liver dysfunction, and leukocytopenia with reactivation of human herpes virus 6. Atypical drug-induced hypersensitivity (DIHS) was diagnosed, and prednisolone was administered at 60 mg/day. However, liver failure rapidly progressed, and the patient died 12 days following treatment. Despite the rarity of DIHS with concomitant fulminant liver failure from levetiracetam and sufficient clearance thereof by hemodialysis, our case suggests that this syndrome may still ensue, resulting in mortality, even in hemodialysis patients. Although no treatment has yet been established, strict monitoring and aggressive treatment may be required.

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Drug Administration and Pharmacogenomics in Children Receiving Acute or Chronic Renal Replacement Therapy

Blowey¹,

Leeder²,

Blowey³

2021

Pediatric Dialysis

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Haemodialysis significantly reduces serum levetiracetam levels inducing epileptic seizures: Case report

Abstract: Haemodialysis reduces serum levetiracetam concentration and can lead to subtherapeutic levels. Close monitoring is necessary when dialysis is used on patients receiving anticonvulsant drugs that are extensively eliminated by the procedure.

Cited by 5 publications

References 11 publications

Serum perampanel levels in patients with seizures are not affected by hemodialysis

Serum perampanel levels in patients with seizures are not affected by hemodialysis

Atypical, Levetiracetam-induced Hypersensitivity Syndrome Complicated by Fulminant Liver Failure in a Patient Undergoing Hemodialysis

Drug Administration and Pharmacogenomics in Children Receiving Acute or Chronic Renal Replacement Therapy

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