Cardiovascular toxicity with levetiracetam overdose
Colin B Page1,2,3, Ahmed Mostafa4,5, Ana Saiao1
1a Clinical Toxicology Research Group , University of Newcastle , Newcastle , Australia ;
Clinical Toxicology (Philadelphia, Pa.)
|January 23, 2016
Summary
Large levetiracetam ingestions can cause bradycardia and hypotension, potentially treatable with atropine and fluids. Overdose pharmacokinetics were similar to therapeutic dosing, with full recovery in 48 hours.
Area of Science:
- Pharmacology
- Toxicology
- Cardiology
Background:
- Levetiracetam is an antiepileptic drug with a known therapeutic range.
- Overdose cases are rare, and cardiovascular effects are not well-documented.
Observation:
- A patient presented with central nervous system depression, bradycardia, hypotension, and oliguria after ingesting 60-80 g of levetiracetam.
- Cardiovascular toxicity transiently responded to atropine and intravenous fluids.
- Echocardiogram showed normal ventricular contractility, and renal function and lactate levels remained normal.
Findings:
- Levetiracetam overdose (463 mcg/ml) caused bradycardia and hypotension.
- The patient recovered fully within 48 hours.
- Pharmacokinetics in overdose were consistent with a one-compartment model and a 10.4-hour elimination half-life, similar to therapeutic dosing.
Implications:
- High-concentration levetiracetam may affect muscarinic receptors, leading to cardiovascular effects.
- Prompt management with atropine and fluids can be effective.
- Levetiracetam overdose pharmacokinetics do not significantly deviate from therapeutic ranges.
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