Affiliations 

  • 1 Department of Internal Medicine, Hospital University Sains Malaysia, School of Medical Science, Kota Bharu, Kelantan, and Dermatology Unit, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 2 Dermatology Unit, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 3 Department of Internal Medicine, Hospital University Sains Malaysia, School of Medical Science, Kota Bharu, Kelantan, Malaysia
  • 4 Reconstructive Sciences Unit, Hospital University Sains Malaysia, School of Medical Science, Kota Bharu, Kelantan, Malaysia
Am J Health Syst Pharm, 2024 Jan 24;81(3):e69-e72.
PMID: 37864830 DOI: 10.1093/ajhp/zxad264

Abstract

PURPOSE: Levetiracetam is an antiepileptic drug known for its high tolerability, and severe adverse drug reactions are rare. We report the case of a severe cutaneous adverse drug reaction in a patient who was switched from brand-name to generic levetiracetam.

SUMMARY: A 29-year-old woman undergoing contrast-enhanced computed tomography developed lesions over her trunk starting 6 hours after imaging. Although initially diagnosed as an allergy to the radiocontrast agent, the condition progressively worsened into toxic epidermal necrolysis-drug reaction with eosinophilia and systemic symptoms overlap syndrome, despite adequate hydration and treatment. Investigation of the patient's medications revealed that she had been switched from brand-name to generic levetiracetam a week before the onset of symptoms. Levetiracetam was immediately discontinued, with the patient recovering after 2 weeks of intensive care. Adverse drug reaction analysis identified excipients in generic levetiracetam as the likely cause of the severe reaction.

CONCLUSION: This is the first reported case of severe cutaneous drug allergy after a brand-to-generic switch for levetiracetam. Brand-to-generic switches of medications can potentially cause severe allergic reactions due to differences in excipients.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.