Keppra (Levetiracetam) and Ketonuria
Keppra (levetiracetam) is not known to directly cause ketones in urine (ketonuria). According to the available guidelines, levetiracetam is classified as a weight-neutral anti-epileptic medication 1, and there is no evidence in the literature linking it directly to ketone production.
Understanding Ketonuria and Its Common Causes
Ketonuria occurs when ketone bodies are present in urine, typically resulting from:
- Diabetes, particularly diabetic ketoacidosis (DKA)
- Starvation or prolonged fasting
- Low-carbohydrate diets
- Pregnancy (found in up to 30% of first morning urine specimens) 1
- After hypoglycemic episodes 1
- Alcoholic ketoacidosis
Medication Considerations with Levetiracetam
Levetiracetam has several known side effects, but ketonuria is not among the commonly reported ones:
- Most common adverse effects: somnolence, headache, asthenia, dizziness, infection 2
- Less common effects: accidental injury, pharyngitis, pain, rhinitis, abdominal pain, etc. 2
- Rare but serious effects: acute kidney injury 3, respiratory depression (in overdose) 4
Clinical Implications
If a patient on levetiracetam presents with ketonuria, consider these more likely explanations:
Unrelated metabolic conditions: The ketonuria may be due to undiagnosed diabetes, fasting, or dietary changes rather than the medication itself.
Medication interactions: While levetiracetam has minimal drug interactions due to its lack of hepatic metabolism 5, it's important to review the patient's complete medication list.
Reduced oral intake: Some patients on levetiracetam experience nausea, vomiting, or anorexia 2, which could lead to reduced caloric intake and subsequent ketosis.
Renal considerations: Since levetiracetam is primarily eliminated through the kidneys 6, patients with renal impairment might experience drug accumulation, potentially affecting metabolism, though this hasn't been directly linked to ketosis.
Monitoring Recommendations
If a patient on levetiracetam presents with ketonuria:
- Evaluate for signs and symptoms of diabetes or DKA
- Check blood glucose levels
- Consider measuring serum β-hydroxybutyrate if DKA is suspected 1
- Review the patient's diet and eating patterns
- Assess renal function, as levetiracetam requires dose adjustment in renal impairment
Key Takeaway
While ketonuria warrants investigation, it is unlikely to be directly caused by levetiracetam therapy. The presence of ketones in urine should prompt evaluation for more common causes such as diabetes, dietary changes, or fasting states.