Keppra (levetiracetam) Disease Interactions
There are 4 disease interactions with Keppra (levetiracetam):
Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs across multiple indications in either monotherapy or adjunctive therapy for a median treatment duration of 12 weeks (up to a maximum of 24 weeks) showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. The estimated rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% for 16,029 placebo-treated patients, representing an increase of approximately one case for every 530 patients treated. There were four suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The increased risk of suicidal thoughts or behavior was observed as early as one week after starting AEDs and persisted for the duration of treatment assessed. The risk did not vary substantially by age (5 to 100 years) in the clinical trials analyzed. Therapy with AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. For clinically significant or persistent symptoms, a dosage reduction or treatment withdrawal should be considered. If patients have symptoms of suicidal ideation or behavior, treatment should be discontinued.
Levetiracetam is removed by hemodialysis. Approximately 50% of the pool of levetiracetam in the body is removed during a standard 4-hour hemodialysis session. The manufacturer recommends a 250 to 500 mg supplemental dose following dialysis.
Levetiracetam is primarily eliminated unchanged by the kidney. The clearance of levetiracetam is decreased in patients with renal impairment and is correlated with creatinine clearance. In study subjects with varying degrees of renal impairment, total body clearance of levetiracetam was reduced by 40% in the mild group (CrCl = 50 to 80 mL/min), 50% in the moderate group (CrCl = 30 to 50 mL/min), 60% in the severe group (CrCl < 30 mL/min), and 70% in anuric patients (end-stage renal disease) compared to patients with normal renal function (CrCl > 80 mL/min). Therapy with levetiracetam should be administered cautiously at reduced dosages in patients with impaired renal function. Dosage adjustments should be based on the degree of renal impairment (i.e. estimated creatinine clearance) in accordance with the product package labeling.
The use of levetiracetam may be associated with minor decreases in total red blood cell count, hemoglobin, and hematocrit. Possibly significant decreases in white blood cell and neutrophil counts may also occur infrequently, although these changes may return to normal despite continued treatment. Therapy with levetiracetam should be administered cautiously in patients with or predisposed to anemia or neutropenia.
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Keppra (levetiracetam) drug Interactions
There are 473 drug interactions with Keppra (levetiracetam)
Keppra (levetiracetam) alcohol/food Interactions
There is 1 alcohol/food interaction with Keppra (levetiracetam)
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
|Major||Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderate||Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|Minor||Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.|
Do not stop taking any medications without consulting your healthcare provider.
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