Does Keppra Impact The Enzymes In The Liver?

Elevated liver enzymes are reported in less than one in ten patients following treatment with Levetiracetam (LEV), which is considered beneficial due to its low potential for drug-drug interactions. Severe liver injury is rarely associated with LEV, and treatment with antiseizure medications (ASMs) can lead to drug-induced liver injury (DILI), especially for older ASMs. Levetiracetam does not inhibit or induce hepatic enzymes and most of it is eliminated unchanged by the kidneys. An elevated partial thromboplastin time (PTT) or decrease in albumin along with elevated liver enzymes is a more specific marker of liver dysfunction.

Carbamazepine (CBZ), valproic acid, phenytoin, and felbamate have a well-recognized association with liver toxicity. Other antiepileptic drugs, including phenobarbital and benzodiazepines, have been shown to have a well-recognized association with liver toxicity. In vitro and in vivo studies have shown that levetiracetam does not act as a cytochrome P450 inductor, meaning it does not cause liver function alterations.

In a case of acute liver failure, the patient’s liver enzymes continued to increase, leading to the decision to stop Levetiracetam. Older antiepileptic medications that induce liver enzyme pathways may be associated with elevated transaminases, but rarely cause hepatotoxicity. It is important to have a strong degree of suspicion and withdraw the drug if you suspect an adverse reaction.

Can a seizure cause elevated liver enzymes?

Abstract. Three children were observed to have extensive liver injury following protracted seizures. Two recovered with supportive care and one died from central nervous system complications. When first measured, the levels of aminotransferases were minimally elevated, but they increased to 250 to 8, 000 times normal within 12 to 24 h after the seizure episode. They fell to near normal over the next 8 to 11 days in the survivors, and to one sixth of the peak level by 4 days in the patients who died. A percutaneous liver biopsy from one child demonstrated centrolobular necrosis consistent with severe ischemic injury. Common causes for liver dysfunction, including viral hepatitis, drug hepatitis, and Reye syndrome, were excluded on clinical, serologic, and histologic grounds. We reason that hepatic injury resulted from ischemia. We speculate that prior treatment with anticonvulsants, which are capable of inducing mixed-function oxidases in the liver, aggravated the ischemia-reperfusion injury by increasing the production of reactive oxygen intermediates and reducing cytoprotective mechanisms. Prevention of such injury should be directed toward control of seizures and early respiratory support when seizures occur, not restructuring medication regimens.

Lerman P. Lerman P. Epilepsia. 1986 Nov-Dec;27:706-10. doi: 10. 1111/j. 1528-1157. 1986. tb03598. x. Epilepsia. 1986. PMID: 3780607.

Can seizure meds cause liver damage?

Anti-seizure medications, like phenytoin Anti-seizure medications top many lists as potential causes of liver injury.

Why are my liver enzymes elevated all of a sudden?

Elevated liver enzymes often are a sign of inflamed or damaged cells in the liver. Inflamed or injured liver cells leak higher levels of certain chemicals into the bloodstream. These chemicals include liver enzymes that may appear higher than usual on blood tests.

Can Keppra damage your liver?

Conclusion. Though safe and free of major side effects when comparing to older AED, it is however prudent to note that there are reports of liver injury following levetiracetam, ranging from asymptomatic elevation of transaminases to fulminant hepatic failure. Though routine liver or renal function monitoring may not be needed, it is advisable to keep the patient informed of such possible side effects with the use of newer AED like levetiracetam.

Consent. Since the patient was not fully conscious and alert enough to understand the concept of signing consent (since he was in a rehabilitation phase following intracranial hemorrhage), written informed consent for the publication of the relevant clinical and radiological data was obtained from the patient’s wife.

Data availability. All data underlying the results are available as part of the article and no additional source data are required.

Is levetiracetam hepatotoxic?

A 76-year-old African American woman presented with acute liver injury consistent with drug-induced autoimmune hepatitis (AIH) in the setting of recent levetiracetam (LEV) initiation. Her history was significant for an ischemic stroke two months before presentation complicated by partial seizures with the initiation of LEV 1, 500 mg twice daily. There were no other new medications or supplement use. On admission, her vitals were normal and physical examination revealed dry mucous membranes and orientation only to self without any new neurological deficits. Serologic evaluation revealed low-level titers of autoantibodies, including positive anti-nuclear antibody (ANA), positive anti-smooth muscle antibody (ASMA), and an elevated total immunoglobulin G at 2, 162 g/L. Her anti-mitochondrial antibody was negative. Liver biopsy revealed mild portal and lobular inflammation with mild interface activity, bile duct injury, and bile ductular proliferation without ductopenia, steatosis, or fibrosis. LEV-induced AIH was diagnosed in the setting of positive autoimmune serologies and consistent liver histology. LEV was discontinued on day 5 of hospitalization, and liver tests were markedly improved by day 15. Her encephalopathy resolved with intravenous hydration and electrolyte correction. The patient was lost to follow-up with no repeat laboratory tests after discharge.

What drug damages the liver the most?

Painkillers and fever reducers that contain acetaminophen are a common cause of liver injury, particularly when taken in doses greater than those recommended. People who drink alcohol to excess are more likely to have this problem.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, and naproxen, may also cause drug-induced hepatitis.

• Amiodarone
• Anabolic steroids
• Birth control pills
• Chlorpromazine
• Erythromycin
• Halothane (a type of anesthesia)
• Methyldopa
• Isoniazid
• Methotrexate
• Statins
• Sulfa drugs
• Tetracyclines
• Amoxicillin-clavulanate
• Some anti-seizure medicines
• Disulfiram
• Niacin
• Azathoaprine
• Ketoconazole

Is Keppra toxic to the kidneys?

• At the time of the review, Health Canada had not received any Canadian reports of acute kidney injury related to levetiracetam use.
• A search in the World Health Organization’s Adverse Drug Reaction Database (Vigibase) found more than 150 international reports of acute kidney injury with the use of levetiracetam. The WHO reviewed 39 of these 150 reports in depth and concluded that levetiracetam had possibly caused acute kidney injury.
• In addition, there were 6 cases of acute kidney injury linked to the use of levetiracetam, published in the scientific literature. While the cases noted other factors such as pre-existing diseases, other medications taken at the same time, or other additional medical conditions, a link between the use of levetiracetam and acute kidney injury could not be ruled out.

• Health Canada’s review found a possible link between the use of levitiracetam and the risk of acute kidney injury.
• The current product information for Keppra informs that cases of acute kidney injury have been reported in patients treated with levetiracetam. Health Canada has requested that the other manufacturers of levetiracetam-containing products also update their product information with the same wording.
• Health Canada will continue to monitor side effects information involving levetiracetam, as it does for all health products on the Canadian market, to identify and assess potential harms. Health Canada will take appropriate and timely action, if and when any new health risks are identified.

The analysis that contributed to this safety review included scientific and medical literature, international adverse reaction reports and what is known about the use of this drug both in Canada and internationally.

Is Keppra bad for organs?

• Levetiracetam is authorized for sale in Canada, to help reduce the number of seizures when taken together with other seizure medicines.
• Health Canada reviewed the potential risk of acute kidney injury with the use of levetiracetam, because of an article that was published by the World Health Organization (WHO) suggesting this risk.
• Health Canada’s review concluded that there may be a link between the use of levetiracetam and the risk of acute kidney injury. The current product information for Keppra informs that cases of acute kidney injury have been reported in patients treated with levetiracetam. Health Canada has requested that the other manufacturers of levetiracetam-containing products also update their product information with the same wording.

Health Canada reviewed the potential risk of acute kidney injury with the use of levetiracetam, because of an article that was published by the WHO suggesting this risk. Health Canada assessed the risk of acute kidney injury, which is defined as a sudden loss of kidney function, including kidney failure and interstitial nephritis. Interstitial nephritis is the inflammation of the kidneys and is one of the conditions that may lead to kidney failure.

• Levetiracetam is a prescription drug authorized for sale in Canada, to help reduce the number of seizures when taken together with other seizure medicines.
• Levetiracetam is available in Canada as oral tablets. It has been marketed under the brand name Keppra since 2003. Generic products are also available.
• There were about 583 000 prescriptions of levetiracetam-containing products filled in 2015.

What anticonvulsants are safe for the liver?

(Review of the use of anticonvulsants in patients with liver disease recommends use of agents that have little hepatic metabolism such as levetiracetam, lacosamide, topiramate, gabapentin and pregabalin, lacosamide being a good choice because of linear pharmacokinetics, only partial hepatic metabolism, with inactive metabolites and lack of clinically significant CYP450 interactions).

What are the 10 worst medications for your liver?

Prescription drugs:Statins. Antibiotics like amoxicillin-clavulanate or erythromycin. Arthritis drugs like methotrexate or azathioprine. Antifungal drugs. Niacin. Steroids. Allopurinol for gout. Antiviral drugs for HIV infection.

Toxic liver disease, or drug-induced liver injury (DILI), is damage to your liver. It’s also called hepatotoxicity or toxic hepatitis. It can cause serious symptoms or liver damage if you don’t get help.

Medications, herbal supplements, chemicals, solvents, and alcohol are all possible causes of hepatotoxicity.

Your liver filters everything that goes into your body. It clears out alcohol, drugs, and chemicals from your blood. Then it processes the unwanted bits so you can flush them out through your urine or bile.

What enzyme is elevated after a seizure?

Creatine Kinase in Serum After Generalized Seizures.