levetiracetam and Hyponatremia

Levetiracetam and phenytoin are comparable for acute posttraumatic seizure(PTS) prophylaxis. Levetiracetam-induced hyponatremia has been reported in non-trauma patients. We studied hyponatremia in posttraumatic intracranial hemorrhage(ICH) patients receiving either drug.. Retrospective review of patients with ICH receiving PTS prophylaxis was performed. Patients were categorized by degree of sodium nadir: normal, mild, moderate, or severe, and analyzed by levetiracetam versus phenytoin. Patients were matched 2:1 regarding age and injury severity score(ISS). Incidence and treatment for hyponatremia was examined.. 1735 ICH patients received PTS prophylaxis over an 8-year period. After exclusions and matching, there were 282 phenytoin and 564 levetiracetam patients. Age, ISS and initial sodium were comparable between the matched cohorts. There was no clinically significant difference in the rate or degree of hyponatremia. Treatment was more common in levetiracetam patients.. There was a small but clinically insignificant difference in the incidence of hyponatremia in traumatic ICH patients receiving levetiracetam vs. phenytoin for PTS prophylaxis. There was an increased rate of intervention for hyponatremia in the levetiracetam group, possibly due to a coincidental preventive paradigm shift.

Topics: Adult; Anticonvulsants; Brain Injuries, Traumatic; Early Medical Intervention; Female; Humans; Hyponatremia; Incidence; Levetiracetam; Male; Middle Aged; Phenytoin; Retrospective Studies; Seizures; Young Adult

Topics: Adolescent; Anticonvulsants; Blood Coagulation Disorders; Child; Child, Preschool; Drug Monitoring; Epilepsy; Female; Humans; Hypokalemia; Hyponatremia; Infant; International Normalized Ratio; Levetiracetam; Magnesium; Male; Partial Thromboplastin Time; Potassium; Prospective Studies; Prothrombin Time; Serum Albumin; Serum Globulins; Sodium; Water-Electrolyte Imbalance

Topics: Aged; Anticonvulsants; Humans; Hyponatremia; Levetiracetam; Male; Seizures

Hyponatremia induced by antiepileptic drugs is common, but detailed evidence is lacking. This can be problematic for the treating neurologist confronted with a patient with severe hyponatremia in need of an alternative drug. The objective of this study was to examine the association between individual antiepileptic drugs and hospitalization due to hyponatremia.. This was a register-based case-control study of patients in the general Swedish population. We included 14,359 individuals with a principal diagnosis of hyponatremia and 57,383 matched controls. The association between newly initiated (≤90 days) and ongoing antiepileptic treatment was investigated using multivariable logistic regression adjusting for concomitant drugs, medical conditions, previous hospitalizations and sociaoeconomic factors.. For newly initiated antiepileptic drugs, adjusted ORs (95% CI) for hospitalization due to hyponatremia, compared to controls, were: carbamazepine 9.63 (6.18-15.33); phenytoin 4.83 (1.14-25.76); valproate 4.96 (2.44-10.66); lamotrigine 1.67 (0.70-4.08); levetiracetam 9.76 (4.02-27.59) and gabapentin 1.61 (1.08-2.38). Newly initiated oxcarbazepine treatment was only found in the hyponatremia group and not in controls. Adjusted ORs (CI) for individuals with ongoing treatment ranged from 7.97 (3.70-18.50) for oxcarbazepine to 0.83 (0.64-1.06) for gabapentin.. There was a strong association between newly initiated treatment with carbamazepine, oxcarbazepine and levetiracetam, and hospitalization due to hyponatremia. The corresponding association for phenytoin and valproate was moderate. The risk for hyponatremia was lower during ongoing treatment. Lamotrigine and gabapentin had the lowest risk both during initiation and ongoing treatment and may be advantageous in patients at risk of developing hyponatremia.

Topics: Aged; Amines; Anticonvulsants; Carbamazepine; Case-Control Studies; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Hospitalization; Humans; Hyponatremia; Lamotrigine; Levetiracetam; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Oxcarbazepine; Piracetam; Registries; Retrospective Studies; Time Factors; Triazines

Hyponatremia is frequently seen in heart failure patients and has a high mortality rate. If not treated adequately, acute and chronic hyponatremia may worsen the prognosis of heart failure. Despite its high incidence in heart failure patients, other underlying conditions that possibly lead to the incidence of hyponatremia may be underestimated, thus making its treatment more difficult. In this case study, we describe a rare case of levetiracem-induced and tolvaptan-resistant hyponatremia.

Topics: Aged; Anticonvulsants; Antidiuretic Hormone Receptor Antagonists; Benzazepines; Epilepsy; Heart Failure; Humans; Hyponatremia; Inappropriate ADH Syndrome; Levetiracetam; Male; Piracetam; Tolvaptan

Topics: Aged; Anticonvulsants; Female; Humans; Hyponatremia; Levetiracetam; Piracetam

Topics: Aged; Anticonvulsants; Epilepsy, Complex Partial; Humans; Hyponatremia; Levetiracetam; Male; Piracetam; Water-Electrolyte Imbalance

Levetiracetam (LEV) is increasingly used as adjunctive anticonvulsant therapy because of apparent low toxicity. Somnolence, asthenia, headache, dizziness, and nervousness are the most frequently reported side effects (1). We describe a patient, predisposed to the development of the syndrome of inappropriate antidiuretic hormone secretion (SIADH), in whom hyponatremia developed after two challenges of LEV.

Topics: Aged; Anticonvulsants; Carbamazepine; Drug Therapy, Combination; Epilepsy; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Levetiracetam; Piracetam; Sodium

The authors examined sodium concentrations from 97 oxcarbazepine-treated (OXC) and 451 carbamazepine-treated (CBZ) patients with epilepsy using cross-section and follow-up studies. The frequency of hyponatremia (Na+ < or = 134 mEq/L) was 29.9% among OXC-treated patients and 13.5% among CBZ-treated patients (p < 0.0001). Hyponatremia (Na+ < or = 128 mEq/L) was severe: 12.4% of OXC-treated patients and 2.8% of CBZ-treated patients (p < 0.001). Advanced age was a risk factor for hyponatremia. Hyponatremia, once present, persisted in both groups.

Topics: Adult; Age Factors; Aging; Anticonvulsants; Carbamazepine; Databases, Factual; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Epilepsy; Female; Humans; Hyponatremia; Levetiracetam; Male; Middle Aged; Oxcarbazepine; Piracetam; Prevalence; Sex Factors; Sodium