Acute Levetiracetam-Induced Thrombocytopenia in an Anticoagulated Immunocompetent Patient

Somto T Nwaedozie,Sheetal Aatrai,Javad Najjar Mojarrab,Abdullah Al Twal

doi:10.7759/cureus.13817

Abstract

Levetiracetam (LEV) is a commonly prescribed anti-seizure medication for the prophylaxis and treatment of focal and generalized seizures. However, a few significant LEV-associated adverse effects have been reported in the literature. Here, we describe a case of significant thrombocytopenia within 24 hours of IV LEV administration for generalized seizures in an anticoagulated immunocompetent patient that completely resolved following discontinuation of the medication. Increased awareness of this uncommon thrombocytopenic side effect of LEV especially in the setting of anticoagulation is important for clinicians providing care to patients with a history of seizures due to the heightened risk of clinically significant bleeding.

Highlights

Levetiracetam (LEV) is a commonly used antiepileptic medication for the prophylaxis and treatment of focal and generalized seizures due to its efficacy, tolerance, good pharmacokinetic profile, and relatively benign adverse effects [1,2,3]
In an open-label placebo-controlled study by Abou-Khalil et al, adverse effects observed in 10% or more of users at individualized doses of 1,000-3,000 mg/day were asthenia, nausea, dizziness, somnolence, nervousness, anorexia, psychiatric side effects as well as other tolerable side effects [4]
Thrombocytopenia has been reported with LEV use in several clinical settings and patient populations, oftentimes along with other thrombocytopenia-inducing medications [1, 7,8,9,10,11,12]

Summary

Introduction

Levetiracetam (LEV) is a commonly used antiepileptic medication for the prophylaxis and treatment of focal and generalized seizures due to its efficacy, tolerance, good pharmacokinetic profile, and relatively benign adverse effects [1,2,3]. Three days later, he developed sudden onset tonic-clonic seizures involving the right upper extremity and clenching of teeth which lasted for several minutes and was aborted with a single dose of 4 mg lorazepam followed by a loading dose of IV LEV (2 g). Considering the patient’s relatively stable hematological profile prior to medication exposure and the temporal relationship between LEV administration and a significant decrease in platelet counts without any other new medication administered, LEV was switched to IV lacosamide at 50 mg twice daily for seizure control This resulted in a rapid and complete resolution of thrombocytopenia within one week and never required platelet transfusion. He was subsequently discharged to a skilled nursing facility for further rehabilitation

Discussion

Conclusions

Findings

Disclosures