Is there a contraindication to taking ivermectin and fenbendazole with Keppra (levetiracetam)?

Drug Interactions Between Ivermectin, Fenbendazole, and Keppra (Levetiracetam)

There is no documented contraindication to taking ivermectin and fenbendazole with Keppra (levetiracetam), as these antiparasitic agents do not interact with levetiracetam through metabolic or pharmacodynamic pathways.

Metabolic Profile Analysis

Levetiracetam Characteristics

• Levetiracetam has minimal drug interaction potential because it is not metabolized by cytochrome P450 enzymes and does not induce or inhibit these pathways 1
• The drug is primarily eliminated unchanged through renal excretion, avoiding hepatic metabolism that could create interaction risks 1

Ivermectin Characteristics

• Ivermectin does not significantly interact with medications lacking P-glycoprotein (P-gp) involvement 2
• Studies demonstrate ivermectin can be safely combined with multiple other antiparasitic agents without clinically significant interactions 3, 4
• When co-administered with other drugs, ivermectin showed no major pharmacokinetic interactions with agents not involving P-gp or CYP3A4 pathways 4

Fenbendazole Characteristics

• Fenbendazole has been safely combined with ivermectin in multiple veterinary and clinical contexts without documented adverse interactions 5
• The combination of ivermectin + fenbendazole showed 100% efficacy without safety concerns in controlled studies 5

Safety Considerations

CNS Effects

• Monitor for additive CNS effects (dizziness, sedation) when combining any CNS-active medication with antiparasitic agents, though this risk is minimal with levetiracetam 1
• Levetiracetam's side effect profile (fatigue, dizziness) could theoretically overlap with ivermectin's rare CNS effects, but no documented interactions exist 1

Hepatic Monitoring

• No additional hepatic monitoring is required beyond standard care for levetiracetam, as neither ivermectin nor fenbendazole significantly affects hepatic metabolism relevant to antiepileptic drugs 1

Clinical Recommendations

Administration Protocol

• Administer all three medications as prescribed without timing adjustments, as no pharmacokinetic interactions necessitate dose separation 3, 4
• Standard dosing for ivermectin (200 μg/kg) and fenbendazole can proceed without modification in patients taking levetiracetam 6

Common Pitfalls to Avoid

• Do not confuse levetiracetam with enzyme-inducing antiepileptics (phenytoin, carbamazepine, phenobarbital) that DO interact with ivermectin and other antiparasitic agents 6, 4
• Anticonvulsants like phenytoin, carbamazepine, and phenobarbital decrease albendazole exposure and are contraindicated with certain antiparasitic regimens, but levetiracetam does not share this mechanism 6, 4

Patient Monitoring

• Observe for seizure control stability during antiparasitic treatment, as any acute illness could theoretically affect seizure threshold independent of drug interactions 7
• Ensure adequate renal function if combining with other medications, as levetiracetam relies on renal elimination 1