Levetiracetam and cutaneous adverse reactions: A systematic review of descriptive studies

Abstract

Recently, there have been an increased number of reports on levetiracetam (LEV) induced cutaneous adverse drug reactions (CADRs). We aimed to identify and critically evaluate all the descriptive studies on LEV induced-CADRs and to describe the possible clinical manifestations, management, and treatment outcomes of the condition. Methodology: PubMed and grey literature databases were searched from inception to June 2019 without any restriction. We also performed a bibliographic search for additional studies. Only descriptive studies on LEVinduced CADRs were included for our review. Study selection, data abstraction and quality assessment were performed by two contributors independently and disagreements were settled through consensus or through discussion with a third reviewer. Results: Data from 24 out of 88 studies, which included 25 patients (12 female and 13 male) aged from 40 weeks to 73 years, were reviewed. Patients received between 500 mg/day to 3000 mg/day of LEV. Drug reaction with eosinophilia and systemic symptoms syndrome, Steven-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, generalised hyperpigmentation and leucocytoclastic vasculitis were observed among the included patients. Immediate cessation of LEV, providing supportive care and use of topical antihistamines and anti-inflammatory drugs appeared to be the mainstay of management, and all patients were found to have recovered. Conclusion:Clinicians should be aware of the possible CADRs induced by LEV to avoid the development of a potentially fatal condition. Immediate withdrawal of the drug and supporting care seem to be effective in the management of the CADRs. Registration number: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42019141002.

Incidence rates of severe cutaneous adverse reactions due to antiseizure medication: A nationwide study using health claims data in Korea

“…Structural differences between ZNS and other ASMs might have contributed to this phenomenon, although this issue has not been analyzed. Only a few SCAR cases have been reported to be associated with LVT 26 . No previous SCAR cases due to TPM have been reported.…”

Photodistributed telangiectasia following the use of psychotropic drugs

“…Therapy with levetiracetam is sometimes associated with fever, abdominal pain, facial edema, multiple lymphadenopathies, pharyngitis purulent plaques and periorbital eye swelling. Dermatological adverse effects include leukocytoclastic vasculitis, generalized hyperpigmentation, morbilliform pruritic rash, erythema, urticaria and exanthematous pustulosis 5 …”

“…For both drugs, severe dermatologic syndromes such as Stevens‐Johnson syndrome, toxic epidermal necrolysis and Drug rash with eosinophilia and systemic symptoms (DRESS) are less common. Phototoxic and photoallergic skin reactions may be observed after UV exposure, most often acute phototoxic reactions developing from the first days of treatment 4,5 …”

Delayed hypersensitivity to antiepileptic drugs in children

“…Although most cases were related to aromatic AEDs, including LTG, rare reports of SJS/TEN related to new generation AEDs such as LEV have been published 14‐19 . Recently, there have been an increased number of reports of LEV induced HRs, including severe reactions such as DRESS, SJS/TEN, AGEP, and cytopenia among children and adults 20 …”

“…[14][15][16][17][18][19] Recently, there have been an increased number of reports of LEV induced HRs, including severe reactions such as DRESS, SJS/TEN, AGEP, and cytopenia among children and adults. 20 A recent nationwide registry-based population study in Korea showed that VPA and LEV were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as CBZ and LTG. Finally, aplastic anemia, drug-induced liver injury (DILI), and pancreatitis are rare but severe HRs reported in adult and pediatric patients receiving AEDs, especially VPA and those that are aromatic.…”