Levetiracetam-induced Rhabdomyolysis - A Rare Complication

Background: Levetiracetam is an anti-epileptic drug that works by modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein 2A. Levetiracetam is generally well tolerated. Common side effects of levetiracetam include lethargy, drowsiness, headaches, and mood changes. Rhabdomyolysis and an increase in Creatine Kinase (CK) levels are one of the rarely reported effects of levetiracetam. Case presentation: We present a case of a 20-year-old patient with previously known epilepsy (non-compliant with medicine) who presented with a seizure. The patient was given 1 gram of levetiracetam in the emergency department and was kept at a maintenance dose of 500 mg twice a day. The workup revealed acute kidney injury and raised levels of creatinine kinase that peaked at 19,757 IU/L 72 hours after levetiracetam was started. Levetiracetam was later switched to lamotrigine and aggressive intravenous hydration was done. Gradual improvement of CK level was noted accompanied by improvement in renal function. Conclusion: Only a few cases of levetiracetam-induced rhabdomyolysis have been reported worldwide. Our case report highlights the importance of monitoring creatinine and CK levels while treating patients with levetiracetam as rhabdomyolysis can be asymptomatic with a rise in CK levels only.