Management of Fever in Patients Taking Keppra (Levetiracetam)
Fever in patients taking Keppra should be aggressively treated with antipyretic medications (such as acetaminophen/paracetamol) to achieve normothermia, as fever is associated with worse neurological outcomes and is not a contraindication to continuing levetiracetam therapy. 1
Fever Management Approach
Primary Treatment Strategy
Administer antipyretic medications promptly when temperature reaches ≥38°C (100.4°F), as fever worsens outcomes in patients with neurological conditions and appears to be an independent prognostic factor 1
Acetaminophen (paracetamol) is the preferred antipyretic agent for comfort and preventing dehydration in febrile patients 1
Physical cooling methods (fanning, cold bathing, tepid sponging) are not recommended as they cause discomfort without proven benefit 1
Evaluation of Fever Source
Obtain blood and urine cultures, chest radiograph to identify infectious sources when fever develops 1
Follow institutional neutropenic fever guidelines if the patient is neutropenic 1
Consider screening for CMV and EBV in appropriate clinical contexts 1
Perform comprehensive metabolic panel, CBC, CRP, and other inflammatory markers to assess systemic response 1
Levetiracetam-Specific Considerations
Continue levetiracetam therapy during fever management - there is no evidence that fever necessitates discontinuation of this anticonvulsant 2, 3
Monitor for rare adverse effects including elevated creatine phosphokinase (CPK) levels, which have been reported with levetiracetam use in febrile patients 4
Levetiracetam does not induce fever unlike phenytoin, making it a preferred anticonvulsant choice when fever management is a concern 5
Temperature Targets and Monitoring
Target normothermia (temperature <38°C) as elevated temperature is associated with increased intracranial volume and worse outcomes in neurological patients 1
Avoid therapeutic hypothermia (<35°C) as its usefulness for improving functional outcomes remains unclear and is associated with complications 1
Monitor temperature continuously in patients with acute neurological conditions requiring anticonvulsant therapy 1
Important Clinical Pitfalls
Do not attribute fever solely to levetiracetam - while drug fever can occur with any medication, levetiracetam is not commonly associated with fever induction 5
Do not withhold antipyretics based on concerns about masking infection - treating fever improves patient comfort and potentially outcomes 1
Avoid corticosteroids for fever management in patients with intracerebral hemorrhage or elevated intracranial pressure, as they do not improve outcomes 1
Ensure adequate hydration alongside antipyretic therapy to prevent dehydration 1