Literature case analysis of levetiracetam-associated liver injury
10.3760/cma.j.cn114015-20220119-00055
- VernacularTitle:左乙拉西坦相关肝损伤文献病例分析
- Author:
Xiao LIANG
1
;
Shan SHEN
;
Duncan WEI
;
Yahui ZHANG
;
Wen ZHANG
;
Cuicui LU
Author Information
1. 山东第一医科大学附属省立医院药学部，济南 250021
- Publication Type:Journal Article
- Keywords:
Epilepsy;
Pyrrolidinones;
Chemical and drug induced liver injure;
Levetiracetam
- From:
Adverse Drug Reactions Journal
2022;24(8):429-434
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To know the clinical characteristics of liver injury related to levetiracetam (LEV).Methods:The relevant databases at home and abroad (up to August 31st, 2021) were searched and the case reports on LEV-associated liver injury were collected. Clinical information including patients′ basic characteristics, LEV application, concomitant medication, and occurrence, treatment, and outcome of liver injury, etc. were collected and analyzed by descriptive statistical method.Results:A total of 17 patients were enrolled in the study, including 9 males and 8 females, aged from 1 month to 76 years with an average age of 35 years. The primary disease was idiopathic epilepsy in 7 patients and secondary epilepsy in 10 patients. Five cases had comorbidities. Thirteen patients had drug dosage records, all of which were within the range recommended in the labels; 13 patients had concomitant medication. The time from LEV treatment to the occurrence of liver injury ranged from several hours to 5 months in 17 patients and it was ≤2 months in 14 patients. The classification of liver injury was hepatocellular type in 7 patients, cholestasis type in 1 patient, mixed type in 1 patient, and unable to be determined due to lack of relevant data in 8 patients. Clinical symptoms were recorded in 10 patients, including yellowish skin and sclera in 5 cases, fever in 4 cases, nausea in 2 cases, vomiting in 2 cases, and biliuria in 2 cases. LEV was discontinued in 14 patients, 4 of whom did not received other interventions and the liver function was improved or returned to normal 2 to 20 days after drug withdrawal; LEV was replaced with other antiepileptic drugs and/or symptomatic treatments in 10 patients, 9 patients′ liver function were improved or returned to normal (the recovery time was 5-37 days in 5 patients and not recorded in 4 patients), 1 patient had normal liver function after liver transplantation, but the liver injury recurred after LEV use again and was improved after drug withdrawal. Two patients did not stop LEV, one underwent liver transplantation due to liver failure and hepatic encephalopathy, and the prognosis was unknown; the other one developed fulminant liver failure and died. One patient had no record of whether or not stopping LEV, and the liver function returned to normal after artificial liver support treatment.Conclusions:LEV-related liver injury mostly occurred within 2 months after drug administration. The clinical manifestations were similar to the liver injury caused by other drugs. Liver function usually was improved or returned to normal after the drug withdrawal. The patients who did not stop LEV had poor prognosis, and severe cases could lead to liver failure or death.
