Suspected levetiracetam-induced rhabdomyolysis: A case report and literature review.
Seizures; Rhabdomyolysis; Creatine Kinase
BACKGROUND Levetiracetam (LEV) is an anticonvulsant commonly used for treatment of generalized and partial seizure disorder. Some of the common side effects associated with levetiracetam include somnolence, dizziness, headaches, and mood changes. Rhabdomyolysis and increase in creatine kinase (CK) levels is one of the rarely reported effects of LEV. CASE REPORT We report a case of a 22-year-old man admitted for evaluation of new-onset generalized tonic-clonic seizures. The patient was started on levetiracetam 500 mg twice a day, after which his CK levels started to increase, with maximum level of 21 936 IU/L noted on day 5. No improvement in CK levels was observed even with aggressive intravenous hydration. In the absence of any other obvious cause, the persistent elevation in patient's CK levels was suspected to be due to LEV. Our suspicion was supported by significant decrease in CK levels (from 21 936 IU/L to 11 337 IU/L) after about 30 h of discontinuation of LEV. We reviewed cases of LEV-induced rhabdomyolysis reported in the literature over the last decade and found 13 cases with almost similar correlation between initiation of LEV and increase in CK levels. CONCLUSIONS Our case report stresses the importance of close monitoring of CK levels and kidney functions after initiation of LEV, and to consider changing the anticonvulsant medication if CK levels are noted to be significantly high to avoid kidney injury.
Moinuddin IA
The American Journal of Case Reports
2020
2020-10-28
journalArticle
<a href="http://doi.org/10.12659/AJCR.926064" target="_blank" rel="noreferrer noopener">10.12659/AJCR.926064</a>
Cystic Fibrosis Patients With And Without Central Nervous System Complications Following Lung Transplantation
CNS complications; convulsions; cyclosporin neurotoxicity; cyclosporine; cystic fibrosis; heart-transplantation; hyponatremia; liver; lung transplantation; methylprednisolone; neurologic complications; Pediatrics; receiving; recipients; Respiratory System; seizures; stroke; toxicity
Goldstein A B; Goldstein L S; Perl M K; Haug M T; Arroliga A C; Stillwell P C
Pediatric Pulmonology
2000
2000-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/1099-0496(200009)30:3%3C203::aid-ppul4%3E3.3.co;2-x" target="_blank" rel="noreferrer noopener">10.1002/1099-0496(200009)30:3%3C203::aid-ppul4%3E3.3.co;2-x</a>
Safety of Intravenous Infusion of Doripenem
antibiotics; carbapenems; ertapenem; history; hypersensitivity; imipenem; Immunology; Infectious Diseases; meropenem; Microbiology; penicillin allergy; seizures
Carbapenems remain a mainstay for the empirical treatment of serious nosocomial infection. Although the tolerance and safety profile of the carbapenems as a class is favorable, the primary safety concern is the potential for treatment-emergent seizures. In preclinical testing, doripenem, a new carbapenem antibiotic, showed negligible neurotoxic effects. The safety and tolerability of intravenous doripenem was evaluated in 1 phase 2 and in 6 phase 3 clinical trials conducted with patients with nosocomial pneumonia, including ventilator-associated pneumonia; complicated intra-abdominal infection; and complicated urinary tract infection. Safety data were available from 1817 patients who received doripenem and 1325 patients who received 1 of 4 active comparator drugs as part of this development program. Overall, intravenous doripenem was found to be safe and well tolerated, demonstrating a safety profile comparable to that of comparator agents and a limited propensity to induce seizures, including when administered via 1-h or 4-h infusion.
Redman R; File T M
Clinical Infectious Diseases
2009
2009-08
Journal Article
<a href="http://doi.org/10.1086/599813" target="_blank" rel="noreferrer noopener">10.1086/599813</a>
Post-Ictal Transient Atrial Fibrillation As A Rare Manifestation Of Grand Mal Seizure.
Anticoagulation; Atrial fibrillation; Seizures
Atrial fibrillation (AF) most frequently occurs as a consequence of multiple etiologies including valvular disease, coronary artery disease, hyperthyroidism, alcohol ingestion, and pulmonary embolism. However, on rare occasion transient AF may be a result of generalized tonic-clonic seizures (GTCS). A 33-year-old-man presented to the emergency department following GTCS in AF with rapid ventricular response. He had no previous documented history. Diagnostic evaluation including electrolytes, thyroid function, cardiac enzymes, serum and urine drug screen, and two-dimensional echocardiogram were unremarkable. Diltiazem was initiated for rate control with spontaneous conversion to sinus rhythm with no recurrence. AF post-seizure is a rare phenomenon but should be considered in epileptic patients. Anticoagulation must be considered in AF due to the risk of cardioembolic stroke but should be weighed against the potential risk of head injury and subsequent intracranial bleed in patients with grand mal seizures.
Dangol Gulshan Man Singh; Hoffman David A
Journal of atrial fibrillation
2017
2017-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4022/jafib.1643" target="_blank" rel="noreferrer noopener">10.4022/jafib.1643</a>
The Case of the Previously Shaky, Unimmunized, Itchy Infant With Rash and Pancytopenia.
Anticonvulsants/*adverse effects; Antipyretics/therapeutic use; Convulsions; Diagnosis; Differential; Drug Hypersensitivity Syndrome/*diagnosis; Drug Reaction With Eosinophilia and System Symptoms Syndrome – Diagnosis; Exanthema/etiology; Febrile – Drug Therapy; Febrile/drug therapy; Humans; Infant; Male; Pancytopenia/etiology; Phenobarbital – Administration and Dosage; Phenobarbital – Adverse Effects; Phenobarbital/*adverse effects; Seizures
Wolski Thomas P Jr; Blasick Stephanie; Blackford Martha G
Clinical pediatrics
2016
2016-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0009922816629618" target="_blank" rel="noreferrer noopener">10.1177/0009922816629618</a>