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 specific information on the incidence of thrombocytopenia is provided in the drug label, but it is listed as a potential adverse event 1, 1.
From the Research
Levetiracetam (Keppra) can rarely cause thrombocytopenia, which is a reduction in blood platelet count, as documented in medical literature 2, 3, 4, 5. This side effect is uncommon but has been reported in several case studies. Patients taking Keppra who develop unusual bleeding, bruising, or petechiae (small red or purple spots on the skin) should contact their healthcare provider promptly for evaluation. The mechanism by which Keppra might cause thrombocytopenia is not fully understood but may involve immune-mediated processes or direct bone marrow suppression, as suggested by the resolution of thrombocytopenia after withdrawal of levetiracetam in some cases 2, 3. Regular blood count monitoring is not routinely required for all patients on Keppra, but may be recommended for those with pre-existing hematological conditions or if symptoms develop. If thrombocytopenia occurs while taking Keppra, the healthcare provider might consider dose adjustment or medication change depending on the severity of the condition and the necessity of the antiepileptic therapy. Some studies have reported a temporal correlation between levetiracetam therapy and the development of thrombocytopenia, suggesting a possible causal relationship 5. However, the overall incidence of levetiracetam-induced thrombocytopenia is considered rare, and most patients tolerate Keppra without hematological side effects, making this a relatively rare concern in clinical practice. In the context of real-life clinical medicine, it is essential to prioritize the patient's safety and well-being, and therefore, healthcare providers should be aware of the potential risk of thrombocytopenia associated with levetiracetam therapy and monitor patients accordingly.