From the Guidelines
Keppra (levetiracetam) can cause skin-related side effects, including rash, and more severe reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis, although the provided evidence does not specifically discuss skin reactions associated with Keppra 1. When considering the administration of Keppra, it's crucial to weigh the potential benefits against the risks, including skin reactions. The evidence provided focuses on the loading dose and route of administration for antiepileptic medications, including Keppra, in an emergency department setting 1. Key points to consider about Keppra administration include:
- A loading dose of 1,500 mg orally or rapid IV loading up to 60 mg/kg is considered safe and well-tolerated 1.
- The choice between oral and IV administration depends on the clinical scenario and patient factors, as there is a lack of evidence to support one route over the other in preventing early recurrent seizure 1. Given the potential for skin reactions and other side effects, it is essential to monitor patients closely for any adverse effects when initiating or reloading Keppra, and to seek medical attention immediately if any concerning symptoms develop. In real-life clinical practice, the decision to use Keppra must consider the individual patient's risk factors for skin reactions and other side effects, as well as the potential benefits of the medication in managing seizures. The absence of specific information on skin reactions in the provided evidence highlights the need for healthcare providers to rely on their clinical judgment and other available resources when making decisions about Keppra use.
From the FDA Drug Label
Skin and Appendages Pruritus20 Skin Discoloration20 Vesiculobullous Rash20 rash rash, skin discoloration The skin-related adverse events associated with levetiracetam include:
- Pruritus (20%)
- Skin Discoloration (20%)
- Vesiculobullous Rash (20%)
- Rash (reported in several studies) 2
From the Research
KEPPRA and Skin Reactions
- KEPPRA, also known as levetiracetam, is an antiepileptic medication that has been associated with skin reactions, although it is considered relatively safe compared to other antiepileptics 3.
- A case report described a 64-year-old man who developed a diffuse, erythematous, warm, blanching, morbilliform rash after taking levetiracetam for seizure prophylaxis 3.
- The rash dissipated after levetiracetam was discontinued and methylprednisolone was started, suggesting a probable cause for a levetiracetam-induced skin reaction 3.
Cutaneous Adverse Reactions
- Cutaneous adverse reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), are rare but serious events that can be caused by anticonvulsant medications, including levetiracetam 4, 3, 5, 6, 7.
- A study found that carbamazepine was the trigger medication in 48% of cases of cutaneous adverse reactions, and that cross-sensitivity was more common in patients with severe cases of SJS/TEN 4.
- Supportive care is the most universally accepted intervention for SJS/TEN, although adjuvant therapies such as corticosteroids and intravenous immunoglobulin may be used in severe cases 5, 6.
Risk Factors and Management
- Age and total body surface area (TBSA) affected are associated with poor prognosis in patients with TEN/SJS 7.
- The most frequent culprit drugs that cause TEN/SJS include allopurinol, metamizole, and various antibiotics, although levetiracetam has also been implicated in rare cases 3, 7.
- Clinicians should employ interventions with the greatest impact on their patients' condition, and decisions regarding treatment should be made on a case-by-case basis due to the lack of consensus regarding diagnostic criteria and treatment for SJS/TEN 5, 6.