Frågedatum: 2001-12-17
RELIS database 2001; id.nr. 17804, DRUGLINE
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Could levetiracetam (Keppra) precipitate a psychotic reaction? If so, are the symptoms dose-related



Fråga: Could levetiracetam (Keppra) precipitate a psychotic reaction? If so, are the symptoms dose-related and/or reversible?

The question relates to a 39-year-old woman with severe epilepsy and with no previous psychiatric history. She developed psychotic symptoms during topiramate (Topimax) anti-epileptic treatment. Haloperidol (Haldol) 4 mg/d was initiated and topiramat was withdrawn. She was then switched to carbamazepine (Tegretol) and further on to oxacarbazepine (Trileptal). In both cases she tended to develop psychotic symptoms and was therefore finally switched to levetiracetam (500 mg/d). She still requires 4 mg haloperidol/d to keep free from psychotic symptoms.

Sammanfattning: The antiepileptic drugs discussed above are associated with psychiatric adverse effects. So far, there are only two reported cases of psychosis reported for levetiracetam. The reactions seem to be dose-related and reversible. However, the clinical experience is limited since levetiracetam is a new drug on the market.

Svar: Psychiatric disorders and behavioural changes are well known for topiramat (WHO 116 cases including 57 cases of psychosis), carbamazepine (209/52 psychosis), and to a lesser extent, also for oxacarbazepine (7/3 psychosis). Levetiracetam is chemically unrelated to the mentioned antiepileptics above and the mechanism of action is so far unknown (2). Still, similar adverse reactions are reported (WHO 8/1 psychosis) (1-3). In Swedis there is, so far, only one additional case of psychosis related to levetiracetam (registered on the US and Swedish markets in 1999 and September 2000 respectively). In this case the patient recovered upon dose reduction (from 1000 mg/d to 500 mg/d) (4). Other psychiatric adverse effects of levetiracetam such as depression, cognitive or mood changes (eg, agitation, aggressive behaviour, euphoria) are also reported to be dose-related and reversible (1).

We recommend that this case be reported to the Regional Center of the Swedish Adverse Drug Reactions Advisory Committee (SADRAC).

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