From the Guidelines
Yes, cefepime can cause confusion, particularly in patients with renal failure or those who are overexposed to the drug 1.
Cefepime Neurotoxicity
- The main risk factor associated with neurological toxicity of beta-lactam antibiotics, including cefepime, is renal failure, which may cause rapid and significant accumulation of beta-lactams 1.
- A literature review of 37 studies representing 135 cases of neurotoxicity related to cefepime administration showed that cefepime neurotoxicity occurred in 48% of cases in patients overexposed, but in 26% of cases in patients appropriately exposed to the drug taking into account their renal function 1.
- Cefepime trough concentrations above 22 mg/L (when administered by discontinuous infusions) or concentrations at steady state above 35 mg/L (when administered by continuous infusion) has been associated with neurotoxicity in 50% of patients 1.
Clinical Implications
- Patients experiencing unexplained neurological manifestations, such as acute confusional state, encephalopathy, myoclonus, seizures, and status epilepticus, should be evaluated for possible antibiotic toxicity, and therapeutic drug monitoring (TDM) and temporarily suspension of beta-lactam administration should be discussed 1.
From the FDA Drug Label
In the presence of renal insufficiency, hemodialysis, not peritoneal dialysis, is recommended to aid in the removal of cefepime from the body. Accidental overdosing has occurred when large doses were given to patients with impaired renal function. Symptoms of overdose include encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), myoclonus, seizures, neuromuscular excitability and non-convulsive status epilepticus.
Encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), myoclonus, seizures, and non-convulsive status epilepticus have been reported
Patients should be instructed to inform their healthcare provider at once of any neurological signs and symptoms, including encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), myoclonus, seizures, and non-convulsive status epilepticus for immediate treatment, dosage adjustment, or discontinuation of cefepime for injection
Cefepime can cause confusion, especially in cases of overdose or renal insufficiency, as part of a condition known as encephalopathy, which is a disturbance of consciousness that may include confusion, hallucinations, stupor, and coma 2, 2.
From the Research
Cefepime-Induced Neurotoxicity
- Cefepime is a widely used antibiotic that can cause neurotoxicity, including symptoms such as confusion, encephalopathy, myoclonus, seizures, and coma 3, 4, 5, 6, 7
- The exact mechanism of cefepime-induced neurotoxicity is not fully understood, but it is thought to be related to the drug's ability to cross the blood-brain barrier and exhibit concentration-dependent γ-aminobutyric acid (GABA) antagonism 3
- Risk factors for cefepime-induced neurotoxicity include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations 3, 4, 5
Clinical Presentation
- Patients with cefepime-induced neurotoxicity may present with a range of symptoms, including:
- The clinical presentation of cefepime-induced neurotoxicity can be variable and may be similar to other conditions, making diagnosis challenging 3, 4, 5, 6, 7
Diagnosis and Treatment
- Diagnosis of cefepime-induced neurotoxicity is typically made based on a combination of clinical presentation, laboratory tests (including electroencephalography), and imaging studies 3, 4, 5, 6, 7
- Treatment of cefepime-induced neurotoxicity typically involves discontinuation of the drug and supportive care, with some patients requiring additional interventions such as antiepileptic medication or hemodialysis 3, 4, 5, 6, 7