From the FDA Drug Label
The following adverse events have been identified during post-approval use of levetiracetam... thrombocytopenia... PRECAUTIONS Hematologic Abnormalities ... A total of 3.2% of treated and 1.8% of placebo patients had at least one possibly significant (≤2. 8 × 109/L) decreased WBC, and 2.4% of treated and 1.4% of placebo patients had at least one possibly significant (≤1. 0 × 109/L) decreased neutrophil count.
Levetiracetam and Thrombocytopenia:
- Levetiracetam may cause thrombocytopenia, as it has been reported in patients receiving marketed levetiracetam worldwide 1.
- However, the exact frequency and causal relationship to drug exposure are unknown due to voluntary reporting from a population of uncertain size 1.
- No significant changes in platelet counts were reported in the clinical trials, but postmarketing experience suggests a possible association with thrombocytopenia 1.
- Key Points:
- Thrombocytopenia has been reported in postmarketing experience with levetiracetam.
- The frequency and causal relationship are unknown.
- Clinicians should be aware of this potential adverse event when prescribing levetiracetam.
From the Research
Levetiracetam (Keppra) can rarely cause thrombocytopenia, a reduction in blood platelet count, as documented in medical literature, with the most recent and highest quality study suggesting a significant association between levetiracetam use and lower platelet counts 2. This side effect is uncommon but has been reported in several case studies and retrospective analyses, including a study published in 2017 that described a case of status epilepticus treated with levetiracetam, which developed severe thrombocytopenia that was successfully managed by discontinuation of the medication 3. The mechanism by which levetiracetam might cause thrombocytopenia is not fully understood but may involve immune-mediated processes or direct bone marrow suppression, as suggested by earlier studies 4, 5, 6. Some key points to consider include:
- Patients taking Keppra who develop easy bruising, petechiae (small red or purple spots on the skin), or unusual bleeding should contact their healthcare provider promptly.
- Regular blood count monitoring is not routinely required for all patients on Keppra, but may be recommended for those with pre-existing hematological disorders or those taking other medications that affect blood counts.
- If thrombocytopenia develops while on Keppra, the healthcare provider may consider dose adjustment or switching to an alternative antiepileptic medication depending on the severity of the condition and the patient's seizure control needs. It is essential to weigh the benefits of levetiracetam treatment against the potential risks, including thrombocytopenia, and to closely monitor patients for any signs of hematological abnormalities, particularly those with pre-existing conditions that may increase their susceptibility to such adverse effects.