Contraindications to Keppra (Levetiracetam) Administration
The only absolute contraindication to Keppra (levetiracetam) administration is a history of hypersensitivity to levetiracetam or any of its inactive ingredients. 1
Relative Contraindications and Special Considerations
1. Hypersensitivity Reactions
- Previous allergic reaction to levetiracetam or any component of the formulation
- Manifestations may include rash, urticaria, or more severe reactions
2. Renal Impairment
- Not a contraindication but requires dose adjustment based on creatinine clearance 2
- Dosing recommendations for adults with renal impairment:
- Creatinine clearance 50-80 mL/min: 500-1000 mg every 12 hours
- More severe renal impairment requires further dose reduction
3. Behavioral/Psychiatric Considerations
- History of psychiatric disorders increases risk of behavioral adverse effects 3
- Not an absolute contraindication but requires careful monitoring
- Approximately 6.9% of patients discontinue levetiracetam due to behavioral side effects 3
- Risk factors for behavioral adverse effects include:
- History of psychiatric diagnosis
- Faster titration rates
- Symptomatic generalized epilepsy
4. Pregnancy and Breastfeeding
- Not contraindicated but requires risk-benefit assessment
- Should be used during pregnancy only if potential benefit justifies potential risk to fetus
Important Monitoring Considerations
Behavioral Monitoring
- Monitor for irritability, agitation, and other behavioral changes, especially in:
- Patients with intellectual disability
- Patients with psychiatric history
- Approximately 12-15% of patients may experience behavioral adverse effects 2
Renal Function
- Regular monitoring of renal function is recommended
- Dose adjustments should be made based on creatinine clearance values 4
Seizure Control
- Levetiracetam has a favorable safety profile with common adverse effects including:
- Somnolence (10.5-15.2%)
- Asthenia
- Dizziness 2
- About 89% of patients do not report significant adverse effects after loading dose 2
Clinical Pearls
- Levetiracetam has minimal protein binding and lacks cytochrome P450 isoenzyme-inducing potential, resulting in minimal drug interactions 5
- Unlike older antiepileptic drugs (AEDs), levetiracetam is considered a non-enzyme-inducing AED (NEIAED) and is preferred over enzyme-inducing AEDs in patients with brain tumors who are receiving chemotherapy 6
- Slower titration should be considered in patients at higher risk for behavioral side effects 3
- In overdose cases, levetiracetam can cause sedation and respiratory depression, but recovery is typically rapid with supportive care 7
Levetiracetam is generally well-tolerated with a favorable safety profile compared to older antiepileptic medications, making it a common choice for seizure management in various clinical scenarios when not contraindicated by hypersensitivity.