Is it safe to take Keppra (levetiracetam) with Eliquis (apixaban) for one month?

Safety of Taking Keppra (Levetiracetam) with Eliquis (Apixaban) for One Month

Taking Keppra (levetiracetam) with Eliquis (apixaban) for one month is generally safe and does not require dose adjustments, as levetiracetam does not significantly affect apixaban levels or increase bleeding risk.

Drug Interaction Assessment

Pharmacokinetic Considerations

• Levetiracetam, unlike enzyme-inducing antiseizure medications, does not significantly interact with the cytochrome P450 system 1
• While there were theoretical concerns about levetiracetam potentially affecting P-glycoprotein (P-gp) transport (which could affect apixaban levels), recent clinical evidence shows this interaction is not clinically significant 2

Recent Evidence on Safety

• A 2023 study specifically examining this combination found no reduction in DOAC plasma levels when used with levetiracetam 2
• In this study of 21 patients concurrently treated with levetiracetam and DOACs (including 9 on apixaban), no thromboembolic events occurred during an observation period averaging over 3.5 years 2
• A 2024 study comparing levetiracetam with enzyme-inducing antiseizure medications showed that unlike enzyme inducers, levetiracetam did not significantly lower apixaban concentrations 1

Advantages of Levetiracetam with DOACs

• Levetiracetam is considered safer than other antiepileptic drugs when combined with anticoagulants because:

  • It has minimal drug-drug interactions 3
  • It does not significantly induce or inhibit liver enzymes that metabolize apixaban 1
  • It has a favorable safety profile with minimal adverse effects 4

• The ESMO consensus guidelines specifically note that "levetiracetam could be safer due to its low interaction with cytochromes" compared to other antiepileptic medications 3

Monitoring Recommendations

While the combination appears safe, consider the following monitoring approach:

1. First week monitoring:

   • Watch for any unusual bleeding or bruising
   • Monitor for any changes in seizure control

2. Throughout the month:

   • No special blood tests are required specifically for this drug combination
   • Continue regular monitoring as would be done for either medication individually

Potential Concerns

• If the patient has severe renal impairment (CrCl <30 mL/min), closer monitoring may be warranted as both drugs have some degree of renal clearance 3
• If the patient is elderly (>75 years) or has low body weight (<60 kg), standard monitoring for apixaban is still appropriate 3

Conclusion

The combination of levetiracetam and apixaban for one month is supported by recent clinical evidence showing no significant interaction affecting drug levels or clinical outcomes. Unlike enzyme-inducing antiepileptic drugs that can significantly reduce apixaban levels and efficacy, levetiracetam maintains therapeutic anticoagulation while providing seizure control.