Acute Liver Injury during Co-treatment with Levetiracetam and Temozolomide

Abstract

Drug-induced liver injury (DILI) accounts for approximately 10 percent of all cases 
of acute hepatitis. The patterns of acute injury include any form of hepatic injury, but the most 
common problems are cholestasis, hepatocellular damage, or a mixed type. DILI is often reversible, and discontinuation of the offending agent usually results in a complete recovery; 
however, some cases may lead to chronic liver injury, cirrhosis, and even death. Temozolomide 
(TMZ) is an alkylating, anti-neoplastic agent used for the treatment of refractory anaplastic 
astrocytoma, newly-diagnosed Glioblastoma multiforme (GBM) and metastatic melanoma. 
Levetiracetam (LEV) is an established second-generation antiepileptic drug and is most commonly approved as adjunctive treatment of partial-onset seizures with or without secondary 
generalization. When administered separately each of these drugs is considered to be relatively 
safe and only few cases of severe liver injury can be found throughout the literature; however, 
LEV and TMZ are commonly used together in the treatment of brain malignancies. We report 
three patients who presented with jaundice during treatment with TMZ and LEV, and propose 
a mechanism for liver sensitization by LEV for TMZ-induced injury.