Can Keppra (levetiracetam) cause sudden diaphoresis?

Levetiracetam (Keppra) and Sudden Diaphoresis

Levetiracetam (Keppra) is not associated with sudden diaphoresis as a known or common side effect based on available clinical evidence and guidelines.

Side Effect Profile of Levetiracetam

Levetiracetam is a commonly used antiepileptic medication with a generally favorable safety profile compared to many other antiepileptic drugs. According to clinical guidelines, the most commonly reported adverse effects of levetiracetam include:

• Fatigue and somnolence
• Dizziness
• Headache
• Behavioral effects (irritability, agitation)
• Rare infusion site pain (with IV administration) 1

In the comprehensive clinical guidelines for seizure management, levetiracetam's adverse effect profile is specifically noted to include "fatigue, dizziness, rarely pain at infusion site" but does not mention diaphoresis 1. Similarly, in neurological guidelines for brain tumor patients, levetiracetam is recommended as a preferred non-enzyme-inducing antiepileptic drug without mention of diaphoresis as a concern 1.

Autonomic Effects of Antiepileptic Medications

While some medications can cause autonomic symptoms including sweating:

1. Research studies on levetiracetam specifically note that it "exhibits a very favourable safety profile" with the most prominent adverse effects being "somnolence, asthenia and dizziness" in clinical trials 2.

2. Even in overdose situations, documented effects of levetiracetam include sedation and respiratory depression, but not diaphoresis 3.

3. A comprehensive review of levetiracetam's use in epilepsy noted that "most events being mild to moderate in severity" without mention of autonomic effects like diaphoresis 4.

Potential Mechanisms for Sweating with Medications

Some medications can cause diaphoresis through:

• Serotonergic effects (like SSRIs)
• Autonomic nervous system modulation
• Withdrawal phenomena

Notably, the clinical policy on seizure management mentions that Serotonin Syndrome (which can include diaphoresis) is associated with serotonergic drugs, but levetiracetam is not included in this category 1. Unlike some other medications, levetiracetam has not been documented to cause withdrawal-related adverse events that might include diaphoresis 5.

Rare Adverse Effects of Levetiracetam

While levetiracetam has been associated with some rare adverse effects, these primarily include:

• Behavioral effects (irritability, agitation, anger) in approximately 12-15% of patients 2
• Rare cutaneous reactions (as documented in case reports) 6

Clinical Implications

If a patient on levetiracetam experiences sudden diaphoresis:

1. Consider alternative causes of the diaphoresis
2. Evaluate for other concurrent medications that may cause diaphoresis
3. Assess for possible seizure activity (as diaphoresis can be a manifestation of certain seizure types)
4. Rule out Serotonin Syndrome if the patient is on multiple serotonergic medications

Conclusion

Based on the available evidence, sudden diaphoresis is not a recognized adverse effect of levetiracetam therapy. If a patient on levetiracetam presents with sudden diaphoresis, clinicians should investigate other potential causes rather than attributing it to the medication.