Keppra (Levetiracetam) and Urinary Retention
Urinary retention is not a recognized or documented side effect of Keppra (levetiracetam) based on available clinical evidence and guidelines. Unlike medications with anticholinergic properties or those affecting autonomic nervous system function, levetiracetam does not have a pharmacological mechanism that would be expected to impair bladder emptying.
Mechanism and Pharmacology
- Levetiracetam works through binding to synaptic vesicle protein SV2A and does not possess anticholinergic, alpha-adrenergic, or other autonomic effects that typically cause urinary retention 1
- Drugs that cause urinary retention typically work through anticholinergic activity (antipsychotics, antidepressants), alpha-adrenoceptor agonism, opioid effects, or calcium channel antagonism—none of which apply to levetiracetam 1, 2
Medications That Actually Cause Urinary Retention
For clinical context, the following drug classes are well-established causes of urinary retention:
- Anticholinergic medications: Antipsychotic drugs, tricyclic antidepressants (amitriptyline, nortriptyline), and anticholinergic respiratory agents 3, 1, 2
- Antimuscarinics for overactive bladder: Should be used with extreme caution in patients with history of urinary retention, and a post-void residual may be useful before initiation 3
- Alpha-adrenergic agonists: Such as midodrine and droxidopa, which can cause urinary retention as a known adverse effect 3
- Antipsychotics: Including quetiapine and others with anticholinergic properties 4, 5
- Opioids and anesthetics: Commonly associated with postoperative urinary retention 1
Clinical Pitfalls to Avoid
- Do not attribute urinary retention to levetiracetam without thoroughly evaluating other concomitant medications, particularly those with anticholinergic properties 1
- Elderly patients are at higher risk for drug-induced urinary retention due to benign prostatic hyperplasia and polypharmacy, making careful medication review essential 1, 2
- SSRIs can rarely cause urinary retention despite not being typically suspected—consider this in patients on escitalopram or similar agents if other causes are ruled out 6
When Urinary Retention Occurs
If a patient on levetiracetam develops urinary retention, the evaluation should focus on:
- Review all concomitant medications for anticholinergic agents, alpha-agonists, antimuscarinics, antipsychotics, or opioids 3, 1
- Assess for benign prostatic hyperplasia in men or anatomical causes in all patients 3
- Consider post-void residual measurement to confirm retention 3
- Evaluate for neurological causes related to the underlying seizure disorder rather than the antiepileptic medication itself 3