Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China.
J Pharm Pharmacol. 2022 Mar 3;74(3):409-414. doi: 10.1093/jpp/rgab181.
Levetiracetam (LEV) has a low risk of hepatotoxicity due to low liver metabolism. Knowledge regarding the association between LEV exposure and liver injury is based mainly on case reports. The purpose of this study is to summarize the clinical features of LEV-induced liver injury.
We collected literature on liver injury induced by LEV for retrospective analysis from 1999 to April 2021 in Chinese and English.
The median age of 21 patients (13 males and 8 females) was 31 years (range 0.13-76). The median time for liver injury was 19 days (range 3-120). The clinical manifestations of patients ranged from asymptomatic elevated liver enzymes in 5 patients (23.8%) to fever, digestive system symptoms and skin rash in 16 patients (76.2%). The median values of alanine aminotransferase and aspartate aminotransferase were 773 IU/L (range 60-4800) and 667.5 IU/L (range 53-10 387), respectively. Liver biopsy demonstrated hepatocellular necrosis. The liver function returned to normal at a median time of 9 days (range 2-270) after discontinuation of LEV.
LEV-induced liver injury is a rare adverse reaction, ranging from asymptomatic elevated transaminases to fulminant liver failure. Patients receiving long-term treatment with LEV should consider monitoring liver function.
左乙拉西坦（LEV）由于肝脏代谢率低，导致肝毒性的风险较低。关于 LEV 暴露与肝损伤之间的关联的知识主要基于病例报告。本研究的目的是总结 LEV 诱导的肝损伤的临床特征。
我们从 1999 年至 2021 年 4 月，以中文和英文收集了关于 LEV 引起的肝损伤的文献进行回顾性分析。
21 例患者（男性 13 例，女性 8 例）的中位年龄为 31 岁（范围 0.13-76）。肝损伤的中位时间为 19 天（范围 3-120）。患者的临床表现范围从 5 例（23.8%）无症状的肝酶升高到 16 例（76.2%）发热、消化系统症状和皮疹。丙氨酸氨基转移酶和天冬氨酸氨基转移酶的中位数分别为 773IU/L（范围 60-4800）和 667.5IU/L（范围 53-10387）。肝活检显示肝细胞坏死。在停用 LEV 后，中位时间为 9 天（范围 2-270）肝功能恢复正常。
LEV 诱导的肝损伤是一种罕见的不良反应，从无症状的转氨酶升高到暴发性肝衰竭不等。接受 LEV 长期治疗的患者应考虑监测肝功能。
