1. Lack of drug interaction between levetiracetam and high-dose methotrexate in patients with lymphoma.
- Author
-
DeFino CE, Barreto JN, Pawlenty AG, Ruff MW, Carabenciov ID, Mara KC, and Thompson CA
- Subjects
- Antimetabolites, Antineoplastic pharmacology, Drug Interactions, Female, Humans, Male, Middle Aged, Retrospective Studies, Levetiracetam pharmacology, Lymphoma drug therapy, Methotrexate pharmacology
- 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/m
2 . 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., (© 2021 Pharmacotherapy Publications, Inc.)- Published
- 2021
- Full Text
- View/download PDF