Levetiracetam-Induced Rhabdomyolysis Following Medication Re-Initiation

Abstract

Rhabdomyolysis is a potentially life-threatening condition in which skeletal muscle breaks down, resulting in the release of myoglobin and creatine kinase (CK) in the blood; CK accumulation can lead to kidney failure and death. Several case reports have reported incidences of levetiracetam (LEV)-induced rhabdomyolysis. However, there are currently no reports of new-onset rhabdomyolysis after restarting LEV in a patient who previously tolerated the medication with no side effects. In this report, we present the case of a 35-year-old male who developed rhabdomyolysis after being restarted on LEV following a generalized tonic-clonic seizure. The patient was loaded with LEV 1 g IV and subsequently restarted on LEV 500 mg PO BID immediately after admission, from which time his serum CK level began to steadily rise to a maximum of 47,078 U/L despite aggressive intravenous hydration. LEV was discontinued on day five of admission when it was suspected to be the cause of the elevated CK levels in the absence of other contributing factors. The patient's CK level decreased to 35,635 U/L on day six of admission and continued to decrease before reaching 5,556 U/L at discharge. It is important to closely monitor serum CK in patients initiating or restarting LEV. Other antiepileptic medications should be considered if CK levels remain persistently elevated without other inciting factors.

Keywords: adverse effect; antiepileptic; creatine kinase; keppra; levetiracetam; medication re-initiation side effect; rhabdomyolysis; seizure medications.

Figure 1. Serum creatine kinase trends from the patient’s previous hospital admission, at which time LEV was initiated on hospital Day 1.

Figure 2. Serum creatine kinase and creatinine trends during the current hospitalization.

Levetiracetam (LEV) was started on Day 1 of admission and halted on Day 5.