Levetiracetam Associated Delirium in an Adult Male – A Case Report
- 1. Department of Pharmacy, University of Wingate, USA
- 2. Department of Pharmacy, Park Ridge Health, USA
Abstract
Delirium is a potentially life-threatening neuropsychiatric medical emergency,
especially in the elderly. Unrecognized or untreated or inappropriately treated
delirium may lead to significant morbidity or mortality. Medication-induced delirium is
not uncommon in elderly patients with complex medication regimens. Medications are
one of the most common precipitating factors for triggering delirium and often one
of the most easily correctable. A case of acute onset visual hallucinations associated
with levetiracetam addition to an extensive medication regimen in an elderly male
with a complex medical and psychiatric history is presented. A Naranjo scale
assessment indicated that the acute delirium was in the probable range, in terms of
its association with levetiracetam. The patient had multiple risk factors (age, multiple
medical comorbidities, history of pre-existing cognitive impairment, treatment with
multiple medications known to be risk factors for delirium) predating addition of the
levetiracetam, however the addition appeared consistent with the time course of the
delirium onset. Levetiracetam prescribing information reports psychotic symptoms in
1% of treated adults versus 0.2% in placebo. New onset psychiatric/behavioral side
effects related to levetiracetam were noted in 15.7% of 221 patients in a study of
newer AEDs in 2007; greater than those seen with gabapentin, lamotrigine, topiramate,
zonisamide, but similar to tiagabine. Anger and aggression were more frequently
reported with levetiracetam than other AEDs (49% versus 39% compared to 7% in
controls).While delirium is typically multifactorial in etiology, increased medication
burden, particularly involving anticholinergics, benzodiazepines, and opiates, among
others, is a significant risk factor. With increased use of levetiracetam for neurological
indications due to efficacy, perceived safety, and cost effectiveness (generic, minimal
monitoring), clinicians should be aware of potential adverse psychiatric manifestations
with this agent.