Rhabdomyolysis: a rare adverse effect of levetiracetam

Abstract

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.

Suspected Levetiracetam-Induced Rhabdomyolysis: A Case Report and Literature Review

“…Of interest, most of the reported cases of LEV-induced rhabdomyolysis were observed in young and adolescent patients between the ages of 19 and 30 years, with only 1 patient being above the age of 60 years [ 12 ]. Peak CK levels observed in these cases were highly variable and ranged between 1368 IU/L and 49 539 IU/L.…”

“…In almost all of the cases included in our literature review, elevation in CK level was observed within 12–36 h of initiation of LEV, suggesting the need for close observation, particularly during the initial treatment phase. In most of the reported cases [ 6 , 12 – 18 ], the time elapsed from initiation of LEV to peak CK elevation was noted to be 3–5 days, after which the medication was discontinued, leading to improvement in CK levels. Symptomatic rhabdomyolysis (back pain, muscle aches) was reported in 5 of 13 cases; our patient, however, did not develop any symptoms of rhabdomyolysis.…”

Suspected Levetiracetam-Induced Acute Rhabdomyolysis in a Patient With Retinoblastoma: A Case Report and Literature Review

“…It was observed that all the reported cases, including ours, were of young patients with ages ranging from 16 to 42 years old and with male predominance [ 3 ]. Only one case was of a patient above 60 years [ 7 ]. Of the 14 cases, only five reported AKI but without requiring RRT [ 5 , 8 - 11 ].…”

Levetiracetam induced rhabdomyolysis

“…At the time of this submission, a total of 14 published levetiracetam-related rhabdomyolysis reports were available for review (Akiyama et al, 2014;Aslan et al, 2020;Incecik et al, 2016;Isaacson et al, 2014;Kubota et al, 2017;Di Lorenzo & Li, 2017;Moinuddin, 2020;Ramon et al, 2016;Rastogi et al, 2018;Rota et al, 2018;Shahbaz et al, 2017;Singh et al, 2014;Sohn et al, 2017;Thomas et al, 2019). No confirmatory studies are able to prove definitively the mechanism behind levetiracetam-induced rhabdomyolysis, a study by Chakkalakal et al suggests the SV2A protein is localized on certain types of muscle fibre (Chakkalakal et al, 2010).…”