Does any medication interact with Keppra (Levetiracetam)?

From the Guidelines

There are no known significant interactions between Keppra (levetiracetam) and most medications, but it is essential to inform your doctor about all medications and products you use, including over-the-counter items, to ensure safe use and minimize potential risks. Keppra is an anti-seizure medication that affects brain chemistry to control seizures, and its interactions with other medications are generally related to its pharmacokinetic properties, such as its metabolism and elimination. However, the provided evidence does not suggest significant interactions between Keppra and other medications that would affect its efficacy or safety profile.

Some medications, such as those that induce or inhibit cytochrome P450 enzymes, may potentially interact with Keppra, but the clinical significance of these interactions is not well established 1. Additionally, medications that affect the renal function or the gastrointestinal pH may also interact with Keppra, but the evidence is limited and inconclusive 1.

It is crucial to note that the lack of significant interactions between Keppra and other medications does not mean that interactions cannot occur. Patients should always inform their doctor about all medications and products they use, including over-the-counter items, to ensure safe use and minimize potential risks. If you experience any unusual side effects or changes in seizure control while using Keppra, contact your doctor promptly, as they may want to monitor you more closely or adjust your treatment plan if needed.

In general, the management of potential interactions between Keppra and other medications involves careful monitoring of the patient's condition, adjustment of medication doses, and consideration of alternative treatments if necessary. The highest quality study, which is the most recent and relevant to the question, should be prioritized when making decisions about medication interactions 1. However, in the absence of strong evidence, a conservative approach is recommended, and patients should be closely monitored for potential interactions and adverse effects.

From the FDA Drug Label

In vitro data on metabolic interactions indicate that levetiracetam is unlikely to produce, or be subject to, pharmacokinetic interactions Levetiracetam and its major metabolite, at concentrations well above Cmax levels achieved within the therapeutic dose range, are neither inhibitors of nor high affinity substrates for human liver cytochrome P450 isoforms, epoxide hydrolase or UDP glucuronidation enzymes. Potential pharmacokinetic interactions were assessed in clinical pharmacokinetic studies (phenytoin, valproate, oral contraceptive, digoxin, warfarin, probenecid) and through pharmacokinetic screening in the placebo-controlled clinical studies in epilepsy patients Drug-Drug Interactions Between Levetiracetam And Other Antiepileptic Drugs (AEDs) Phenytoin Levetiracetam (3000 mg daily) had no effect on the pharmacokinetic disposition of phenytoin in patients with refractory epilepsy. Valproate Levetiracetam (1500 mg twice daily) did not alter the pharmacokinetics of valproate in healthy volunteers. Other Drug Interactions Oral Contraceptives Levetiracetam (500 mg twice daily) did not influence the pharmacokinetics of an oral contraceptive containing 0.03 mg ethinyl estradiol and 0. 15 mg levonorgestrel, or of the luteinizing hormone and progesterone levels, indicating that impairment of contraceptive efficacy is unlikely. Digoxin Levetiracetam (1000 mg twice daily) did not influence the pharmacokinetics and pharmacodynamics (ECG) of digoxin given as a 0. 25 mg dose every day. Warfarin Levetiracetam (1000 mg twice daily) did not influence the pharmacokinetics of R and S warfarin. Probenecid Probenecid, a renal tubular secretion blocking agent, administered at a dose of 500 mg four times a day, did not change the pharmacokinetics of levetiracetam 1000 mg twice daily.

Medication Interactions with Keppra (Levetiracetam)

• No significant interactions were found with the following medications:
  • Phenytoin
  • Valproate
  • Oral contraceptives
  • Digoxin
  • Warfarin
• Potential interaction with probenecid, which may decrease the renal clearance of levetiracetam's metabolite, ucb L057. However, it is unlikely to produce or be subject to pharmacokinetic interactions due to its low affinity for human liver cytochrome P450 isoforms, epoxide hydrolase, or UDP glucuronidation enzymes 2.

From the Research

Medication Interactions with Keppra (Levetiracetam)

• There are several medications that may interact with Keppra, including:
  • Valproic acid: Co-administration of valproic acid and levetiracetam may affect the apparent oral clearance of levetiracetam 3
  • Glucuronidation-inducing drugs: Co-administration of these drugs may increase the apparent oral clearance of levetiracetam 3
• The study also found that patients with renal failure may require closer monitoring when taking levetiracetam, as their glomerular filtration rate (GFR) may be lower 3

Mechanism of Interaction

• The exact mechanism of interaction between levetiracetam and other medications is not fully understood, but it is thought to involve changes in the pharmacokinetics of levetiracetam, such as alterations in its absorption, distribution, metabolism, and excretion 3

Clinical Implications

• Healthcare providers should be aware of the potential interactions between levetiracetam and other medications, and monitor patients closely for signs of adverse effects or changes in seizure control 3, 4
• Patients with renal failure or those taking glucuronidation-inducing drugs may require dose adjustments or closer monitoring when taking levetiracetam 3