Q:  28 year old male is started on Levetiracetam (Keppra) in ICU for new onset seizure. Patient developed generalized mild rash all over the body after 3rd dose. What should be the next step? (choose one best answer)

A) Add anti-histamine with each dose 

B) Add Steroid

C) discontinue Keppra

D) Switch IV formulation to oral

E) Add Pyridoxine (Vitamin B6)

Answer: C

1 out of 3000 patients on Keppra may develop Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Recommendation is to discontinue Keppra upon signs of any unexplained rash. Ideally, Keppra should not be resumed and alternative drug should be considered. Pyridoxine (vitamin B6) is said to curtail some of the psychiatric symptoms arising from  use of Levetiracetam (Keppra).