From the FDA Drug Label
Although most laboratory tests are not systematically altered with levetiracetam treatment, there have been relatively infrequent abnormalities seen in hematologic parameters and liver function tests.
The FDA drug label does not specify particular laboratory tests that are required before initiating Keppra (levetiracetam) therapy in a patient. However, it mentions that hematologic parameters and liver function tests may show abnormalities in some patients.
- Hematologic tests may include:
- White Blood Cell (WBC) count
- Neutrophil count
- Red Blood Cell (RBC) count
- Hemoglobin
- Hematocrit
- Liver function tests may include:
- Alanine transaminase (ALT)
- Aspartate transaminase (AST)
- Alkaline phosphatase
- Bilirubin It is recommended to consult with a healthcare provider to determine the necessary laboratory tests before initiating levetiracetam therapy 1.
From the Research
No specific laboratory tests are required before starting a patient on Keppra (levetiracetam), but it is essential to consider the patient's renal function, as levetiracetam is primarily eliminated by the kidneys. Levetiracetam does not require baseline laboratory monitoring because it has minimal effects on liver function, does not interact significantly with other medications, and doesn't cause clinically significant changes in blood counts 2. Unlike some other antiepileptic drugs such as valproate or carbamazepine, Keppra doesn't require monitoring of drug levels for efficacy. The typical starting dose for adults is 500 mg twice daily, which can be gradually increased to 1500-3000 mg daily in divided doses based on clinical response. For children, dosing is weight-based.
Key Considerations
- Renal function should be considered when dosing, as Keppra is primarily eliminated by the kidneys, and dose adjustments are necessary for patients with significant renal impairment 3, 4.
- Patients with augmented renal clearance may require higher doses, up to 1500 mg twice daily, to achieve similar exposures to those with normal renal function 2.
- While formal lab testing isn't required, it's always good practice to have a general understanding of the patient's baseline health status, including renal function, before starting any medication.
- Patients should be monitored for side effects, which commonly include somnolence, fatigue, and behavioral changes such as irritability or mood disturbances.
Special Populations
- Patients with severe liver cirrhosis may require dose adjustments, as levetiracetam clearance is reduced in these patients 5.
- Patients on continuous venovenous hemofiltration and with acute liver dysfunction may require individualized dosing regimens, but a dose of 1000 mg twice daily may be considered as an empiric regimen 6.