Is there an interaction between Levetiracetam and Acitretin?

No Known Interaction Between Levetiracetam and Acitretin

There is no documented interaction between levetiracetam and acitretin based on current guidelines and available evidence.

Pharmacological Properties of Both Medications

Levetiracetam

• Levetiracetam is an antiepileptic drug with a favorable pharmacokinetic profile that makes its clinical use straightforward 1
• Not significantly protein-bound (<10%) and does not undergo extensive hepatic metabolism 1
• Primarily eliminated unchanged through the kidneys (66% excreted unmetabolized in urine) 1
• Does not induce or inhibit liver enzymes and has minimal potential for drug interactions 1, 2
• Has not shown clinically relevant pharmacokinetic interactions with other antiepileptic drugs 1

Acitretin

• Acitretin is an oral retinoid used primarily for psoriasis treatment 3
• Metabolized through the cytochrome P450 pathway 3
• Known drug interactions include:
  • Drugs affecting cytochrome P450 pathway (e.g., cyclosporine) 3
  • Drugs competing for plasma protein binding (e.g., phenytoin) 3
  • Tetracyclines (risk of increased intracranial pressure) 3
  • Methotrexate (increased risk of hepatotoxicity) 3, 4
  • Antidiabetic agents (risk of hypoglycemia) 3
  • Vitamin A supplements (risk of hypervitaminosis A) 3
  • Alcohol (forms etretinate) 3
  • Progestin-only contraceptives (decreased efficacy) 3

Analysis of Potential Interaction

• Levetiracetam is not listed among drugs that interact with acitretin in any of the guidelines 3
• Levetiracetam has a low potential for drug interactions due to:
  • Minimal protein binding (unlike phenytoin which has a documented interaction with acitretin) 1
  • Limited hepatic metabolism (primarily eliminated unchanged through kidneys) 1
  • No significant effect on cytochrome P450 enzymes 2

Clinical Implications

• No dosage adjustments are needed when co-administering levetiracetam and acitretin 1, 2
• Monitoring considerations:
  • Both medications independently require their own monitoring parameters
  • For acitretin: monitor liver function tests, lipid profile, and renal function 3
  • For levetiracetam: monitor for neurological side effects (somnolence, dizziness) 2

Potential Pitfalls and Caveats

• While no direct interaction between levetiracetam and acitretin is documented, both medications can independently affect liver function 3, 1
• Levetiracetam has recently been identified as potentially having P-glycoprotein induction properties that could interact with direct oral anticoagulants, suggesting its interaction profile may not be completely understood 5
• If both medications are used concurrently, standard monitoring for each medication should be maintained, with particular attention to:
  • Liver function tests (as acitretin can cause hepatotoxicity) 3
  • Neurological symptoms (as levetiracetam can cause CNS effects) 2

Summary of Evidence

• Current guidelines for acitretin list specific drug interactions but do not include levetiracetam 3
• Levetiracetam is known for its minimal drug interaction potential 1, 2
• The pharmacokinetic profiles of these medications suggest low likelihood of interaction 1, 2