Lack of drug interaction between levetiracetam and high-dose methotrexate in patients with lymphoma

Catherine E. DeFino, Jason N. Barreto, Amanda G. Pawlenty, Michael W. Ruff, Ivan D. Carabenciov, Kristin C. Mara, Carrie A. Thompson

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objective: To determine whether there is a drug-drug interaction precluding the concomitant use of levetiracetam and high-dose methotrexate (HDMTX). Design: Retrospective analysis. Setting: Large academic tertiary care medical center. Patients: Adult lymphoma patients who received HDMTX as a 4-h infusion with or without concomitant levetiracetam. Measurements and Main Results: Generalized estimating equations clustered on patient were used to assess each outcome. The primary outcome was the incidence of delayed MTX elimination (MTX level >1 µmol/L at 48 h). Secondary outcomes included incidence of acute kidney injury (AKI) and hospital length of stay (LOS). The 430 included patients receiving 1993 doses of HDMTX had a median (IQR) age of 66 (57.5, 72.6) years, 88 (20.5%) received concomitant levetiracetam with at least one dose of MTX, 267 (62.1%) were male, and 397 (92.3%) were Caucasian. HDMTX doses ranged from 1 to 8 g/m2. The most common lymphoma diagnoses were systemic diffuse large B-cell lymphoma (DLBCL; 58.5%) and systemic DLBCL with central nervous system (CNS) involvement (32.8%). Rates of delayed elimination with and without levetiracetam were 13.4% and 16.3%, respectively (OR = 0.80, 95% CI 0.47–1.34, p = 0.39). AKI occurred in 15.6% and 17.0% of patients with and without concomitant levetiracetam, respectively (OR = 0.83, 95% CI 0.52–1.33, p = 0.28). The median LOS with and without levetiracetam was 4.2 and 4.1 days, respectively (p = 0.039). On multivariable analyses, only age, body surface area, diagnosis of systemic DLBCL with CNS involvement, serum creatinine, hemoglobin, total bilirubin, and dose of HDMTX were associated with delayed elimination. Conclusions: High-dose methotrexate administered with concomitant levetiracetam was not associated with increased risk for delayed MTX elimination or AKI. These results support that levetiracetam and HDMTX are safe for coadministration.

Original languageEnglish (US)
JournalPharmacotherapy
DOIs
StateAccepted/In press - 2021

Keywords

  • acute kidney injury
  • drug interactions
  • levetiracetam
  • lymphoma
  • methotrexate

ASJC Scopus subject areas

  • Pharmacology (medical)

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