From the FDA Drug Label
Levetiracetam is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function Clearance of levetiracetam is decreased in patients with renal impairment and is correlated with creatinine clearance Caution should be taken in dosing patients with moderate and severe renal impairment and in patients undergoing hemodialysis.
Kidney Damage: The FDA drug label does not directly answer whether Keppra (levetiracetam) causes kidney damage. However, it does indicate that:
- Levetiracetam is substantially excreted by the kidney.
- The risk of adverse reactions may be greater in patients with impaired renal function.
- Clearance of levetiracetam is decreased in patients with renal impairment.
- Caution should be taken in dosing patients with moderate and severe renal impairment and in patients undergoing hemodialysis 1 1. Monitoring: It is recommended to monitor renal function in patients with impaired renal function receiving levetiracetam.
From the Research
Levetiracetam (Keppra) can cause kidney damage, particularly in patients with pre-existing kidney impairment or those taking high doses, and therefore requires careful monitoring and dose adjustment in at-risk patients. The potential renal effects of Keppra are a concern, as evidenced by case reports of acute kidney injury associated with its use 2, 3, 4. However, it is essential to note that Keppra is primarily eliminated unchanged through the kidneys, and its pharmacokinetics are highly favorable, making its clinical use relatively simple 5.
Key Considerations
- For patients with normal renal function, no specific renal monitoring is required when taking Keppra.
- In patients with reduced kidney function (creatinine clearance less than 80 mL/min), dosage adjustments are necessary based on the degree of impairment.
- Baseline renal function should be assessed before starting therapy, with periodic monitoring of renal function in at-risk patients, particularly the elderly, those with known kidney disease, or those on nephrotoxic medications 6.
- The most recent and highest quality study 4 suggests that clinicians should be aware of the possibility of severe renal function deterioration in patients with levetiracetam overdose and that induction of dialysis may be beneficial in such cases.
Dose Adjustment Guidelines
- For mild impairment (creatinine clearance 50-80 mL/min), no dose adjustment is typically needed.
- For moderate impairment (creatinine clearance 30-50 mL/min), the recommended dose is 500-1000 mg twice daily.
- For severe impairment (creatinine clearance less than 30 mL/min), 250-750 mg twice daily is recommended.
- Patients on hemodialysis may require supplemental doses after dialysis sessions as the drug is removed during dialysis.
Monitoring and Prevention
- Close monitoring of kidney function is crucial in patients taking Keppra, especially in those with pre-existing kidney disease or those at risk of nephrotoxicity 6.
- Clinicians should be aware of the potential for levetiracetam to cause acute kidney injury, particularly in patients with high doses or pre-existing kidney impairment 3, 4.