Hyperhidrosis and Levetiracetam (Keppra)
No, hyperhidrosis is not a common side effect of levetiracetam (Keppra). The most frequently reported adverse effects are fatigue, dizziness, somnolence, headache, asthenia, infection, pharyngitis, and pain—but hyperhidrosis is not among them 1, 2, 3, 4.
Evidence from Clinical Guidelines and Research
Documented Side Effect Profile
The established adverse effects of levetiracetam based on multiple clinical trials include 1:
- Fatigue and somnolence (most common)
- Dizziness
- Headache
- Asthenia (weakness)
- Behavioral adverse effects in some patients (irritability, aggression) 1, 2, 3
- Rarely, pain at infusion site with IV administration 1
What the Evidence Shows About Hyperhidrosis
When reviewing comprehensive adverse effect data from large-scale trials and systematic reviews, hyperhidrosis (excessive sweating) does not appear as a recognized side effect of levetiracetam 2, 3, 4. The drug has been extensively studied in randomized controlled trials involving hundreds of patients, and sweating was not reported as a treatment-emergent adverse event at rates exceeding placebo 4.
Important Clinical Context
If a patient on levetiracetam develops hyperhidrosis, consider alternative explanations:
- Seizure-related autonomic symptoms - Sweating can be an ictal or post-ictal phenomenon, particularly with temporal lobe seizures
- Concomitant medications - Review other drugs the patient is taking; for example, duloxetine (an SNRI) lists hyperhidrosis as a common adverse effect 1
- Underlying medical conditions - Autonomic dysfunction, hyperthyroidism, or other systemic causes 1
- Withdrawal from other medications - If levetiracetam was substituted for another antiepileptic drug
Safety Profile Advantages
Levetiracetam is notable for what it does NOT cause 2, 3:
- No cognitive impairment
- No drug-induced weight gain (unlike many other antiepileptic drugs)
- No clinically significant drug interactions via cytochrome P450 enzymes
- Minimal metabolism with primarily renal elimination
The overall proportion of patients experiencing adverse events with levetiracetam was similar to placebo in clinical trials, with most events being mild to moderate in severity 2, 3.