Levetiracetam-Induced Anaphylaxis in a Neonate

Abstract

Background

Neonatal seizures are often refractory to treatment with initial antiseizure medications. Clinicians turn to agents such as levetiracetam despite the paucity of published data regarding its safety, tolerability, or efficacy in the neonatal population.

Patient presentation

We describe a neonate who developed anaphylactic shock developing after receiving intravenous levetiracetam.

Results

This is the first neonate to develop anaphylactic shock due to intravenous administration of levetiracetam.

Conclusion

Clinicians should be aware of this potentially fatal adverse effect occurring with intravenous levetiracetam in newborns.

Introduction

The use of some of the newer, already-available antiepileptic drugs has become wider in clinical practice, although off-label, and their results are described in case series. The main example includes levetiracetam, which displays a favorable pharmacokinetic profile and alternative mechanisms of action that could positively affect tolerability and efficacy in the neonatal period.¹ Levetiracetam has few known serious adverse side effects, in contrast to other antiseizure medications, which may cause cardiopulmonary depression, arrhythmia, and coagulopathy. The estimated frequency of hypersensitivity to levetiracetam in children and adults is 0.6%.² These features suggest that levetiracetam could be safe and efficacious in treating neonatal seizures; however, neonatal data are needed.³ To date, anaphylaxis or other life-threatening adverse effects attributable to levetiracetam in neonatal period have not been reported.