Can you take oxycarbazepine with Keppra (levetiracetam)?

Can You Take Oxcarbazepine with Keppra (Levetiracetam)?

Yes, oxcarbazepine and levetiracetam (Keppra) can be safely taken together and this combination is often used in epilepsy management with minimal drug interactions between the two medications.

Compatibility of Oxcarbazepine and Levetiracetam

Oxcarbazepine and levetiracetam are both antiseizure medications (ASMs) that work through different mechanisms of action, making them complementary when used together:

• Levetiracetam (Keppra) has a unique mechanism of action that doesn't significantly interact with the metabolism of other drugs 1
• Oxcarbazepine is a voltage-gated sodium channel modulator that is considered a moderate P-gp or CYP inducer 2

Drug Interaction Profile

The combination has several advantages:

• No clinically significant pharmacokinetic interactions between oxcarbazepine and levetiracetam have been documented 3
• Levetiracetam has minimal drug interactions overall and doesn't require dose adjustments when combined with other ASMs 1, 4
• Unlike many older antiseizure medications, levetiracetam doesn't induce or inhibit liver enzymes that metabolize other drugs 5

Clinical Evidence Supporting Combination Therapy

Research supports the use of these medications together:

• Preclinical studies show that levetiracetam generally enhances the protective activity of other antiseizure medications without exacerbating side effects 4
• Driving studies have shown that continued administration of both oxcarbazepine and levetiracetam does not result in clinically meaningful driving impairment 2
• In treatment guidelines, levetiracetam is listed as having minimal adverse effects compared to other ASMs 1

Potential Benefits of Combination Therapy

The combination may offer advantages in seizure management:

• Different mechanisms of action may provide broader seizure control
• Levetiracetam has been shown to enhance the effects of other ASMs without increasing side effects 4
• Studies have demonstrated that levetiracetam interferes least with clinical and neurophysiologic test results compared to other ASMs like carbamazepine 5

Monitoring Recommendations

When taking these medications together, monitor for:

1. Efficacy: Assess seizure control regularly

2. Side effects: Common side effects include:

   • Dizziness
   • Somnolence
   • Fatigue
   • Headache

3. Cognitive function: Both medications may affect cognitive performance, though levetiracetam typically has less impact than older ASMs 5

Precautions

While the combination is generally safe, be aware of:

• Oxcarbazepine may cause hyponatremia (low sodium levels) 6
• Levetiracetam may cause behavioral changes in some patients 1
• In rare cases, both medications can cause skin reactions

Conclusion

The combination of oxcarbazepine and levetiracetam is pharmacologically compatible and clinically appropriate for many patients with epilepsy. Their different mechanisms of action may provide complementary seizure control without significant drug-drug interactions.