title: Acute pancreatitis and elevated liver transaminases after rapid titration of oral levetiracetam.
abstract: We report a 25-year-old woman with new onset convulsive episodes. The patient initially failed to respond to phenytoin and was switched to levetiracetam (LEV) which was rapidly titrated to 3000 mg daily over 1 week. At initiation of LEV therapy, she developed mild nausea and decrease in appetite. This was rapidly followed by severe digestive symptoms consistent with acute pancreatitis. She was also found to have elevated liver transaminases. An extensive work-up failed to reveal an organic cause for her symptoms, suggesting a direct relationship to LEV. Clinical symptoms and laboratory abnormalities normalized after LEV discontinuation, along with supportive therapy.
authors.affiliation: Vanderbilt University Medical Center, Neurology Department, A-0118 MCN 2551, 1211 Medical Center Drive, Nashville, TN 37232-2551, USA; Veteran's Administration Medical Center, Nashville, TN, USA. Electronic address: nabil.azar@vanderbilt.edu.
authors.forename: Nabil J
authors.initials: NJ
authors.lastname: Azar
authors.affiliation: Veteran's Administration Medical Center, Nashville, TN, USA.
authors.forename: Patsy
authors.initials: P
authors.lastname: Aune
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008099:Liver / Q000187:drug effects / Q000201:enzymology*; D010195:Pancreatitis / Q000097:blood* / Q000139:chemically induced* / Q000175:diagnosis; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D000637:Transaminases / Q000097:blood*
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D000637:Transaminases; D010889:Piracetam
keywords: Idiosyncratic reaction; Levetiracetam; Liver transaminases; Pancreatitis