What vitamins does Keppra deplete and what can you do about it?

While older antiepileptic drugs (AEDs) are well-known for causing nutrient deficiencies, studies show newer AEDs like Keppra (levetiracetam) also have an impact, specifically on Vitamin B6 levels. Supplementation may help mitigate side effects such as irritability, anxiety, and depression that are frequently associated with the medication.

Quick Summary

This article explores the vitamin deficiencies linked to Keppra (levetiracetam) treatment, focusing on the strong association with Vitamin B6 depletion. It discusses the potential impact on mood and includes information on supplementing safely to counteract these side effects.

Key Points

• Vitamin B6 Depletion: Keppra (levetiracetam) is most significantly linked to the depletion of Vitamin B6 (pyridoxine), which can contribute to mood-related side effects.

• Mood-Related Side Effects: Symptoms like irritability, anger, anxiety, and depression associated with Keppra may be tied to low levels of Vitamin B6.

• Potential for Vitamin D Deficiency: Some studies, particularly in children on levetiracetam, have noted a higher prevalence of Vitamin D deficiency, warranting monitoring for long-term users.

• Folate Considerations: While Keppra itself doesn't cause severe folate depletion like older AEDs, women of childbearing age should still discuss supplementation with their doctor.

• Importance of Medical Supervision: Any supplementation should be discussed with a healthcare provider, who can recommend appropriate courses of treatment and monitor nutrient levels.

• Favorable Nutrient Profile: Compared to older AEDs, Keppra has a more favorable profile regarding nutrient interactions, but specific deficiencies, especially B6, are a concern.

Understanding the Link Between Keppra and Vitamin Depletion

Keppra, the brand name for the antiepileptic drug levetiracetam, is a widely prescribed medication for controlling seizures in individuals with epilepsy. Unlike older antiepileptic drugs (AEDs) that are known to interfere with a broad range of nutrients, levetiracetam is generally considered to have a more favorable nutrient interaction profile. However, growing evidence suggests a specific and notable effect on certain B vitamins, particularly Vitamin B6. Understanding this relationship is crucial for managing potential side effects and supporting overall patient health.

The Primary Suspect: Vitamin B6 Depletion

Clinical observations and studies have increasingly pointed to a significant reduction in Vitamin B6 (pyridoxine) levels in some individuals taking Keppra. Vitamin B6 plays a critical role as a cofactor in numerous biochemical reactions, including the synthesis of neurotransmitters like GABA and serotonin. The depletion of this vital nutrient is thought to be the underlying mechanism for some of the medication's common neuropsychiatric side effects.

Evidence from retrospective studies, primarily involving children and veterans, has shown a link between levetiracetam-induced irritability, anger, and anxiety and low Vitamin B6 levels. In these studies, supplementing with pyridoxine led to an improvement in these behavioral symptoms for some patients. While the exact mechanism isn't fully clear, the connection between B6 deficiency and these mood changes is gaining traction in the medical community, suggesting a potential role for supplementation as a mitigation strategy.

Other Potential Vitamin and Nutrient Concerns

While Vitamin B6 is the most strongly implicated nutrient, other vitamins and minerals warrant attention, especially in the context of long-term or polytherapy (taking multiple AEDs) use. It is important to distinguish between older, enzyme-inducing AEDs, which have a more profound effect on nutrient levels, and newer ones like Keppra. However, research suggests that some modern AEDs may still pose risks, and Keppra is no exception.

• Vitamin D: Some studies on children with epilepsy have found a common prevalence of Vitamin D deficiency, even in those on monotherapy with levetiracetam. Vitamin D is crucial for bone health, and its deficiency can lead to conditions like osteomalacia. While Keppra does not directly interfere with Vitamin D metabolism in the way some older AEDs do, monitoring is still advised for long-term users.
• Folate (Folic Acid): Older AEDs are strongly associated with depleting folate levels, which is particularly concerning for women of childbearing age due to the risk of neural tube defects. While several studies suggest levetiracetam does not significantly affect folate levels in adults, supplementation is often a standard precaution for any person of childbearing potential taking AEDs, including Keppra.
• Biotin and L-Carnitine: Long-term anticonvulsant treatment has been shown to decrease blood levels of both biotin and L-carnitine. While the evidence for levetiracetam specifically is less pronounced than with older drugs, it is a factor to consider in overall nutritional status, especially for children undergoing treatment.

Managing Potential Deficiencies: A Proactive Approach

For those taking Keppra, proactively addressing potential vitamin deficiencies is key to mitigating adverse side effects. Here’s a summary of steps and a comparison of strategies.

• Consult Your Healthcare Provider: Always discuss any potential vitamin supplementation with your doctor or pharmacist. They can provide personalized advice and monitor your blood levels if necessary.
• Consider Vitamin B6 Supplementation: For individuals experiencing mood-related side effects, such as irritability or anxiety, discussing a trial of Vitamin B6 (pyridoxine) supplementation with a doctor is a common recommendation.
• Maintain a Balanced Diet: A nutrient-rich diet with plenty of fruits, vegetables, lean proteins, and whole grains can help support overall health and provide essential vitamins and minerals.
• Discuss Folate and Vitamin D Status: Women of childbearing potential should discuss folate supplementation with their doctor, and anyone on long-term therapy may benefit from discussing Vitamin D status, especially with limited sun exposure.

Comparison of Keppra vs. Older AEDs and Vitamin Depletion

Feature	Keppra (Levetiracetam)	Older AEDs (e.g., Phenytoin, Carbamazepine)
Effect on Vitamin B6	Significant potential for depletion, associated with mood-related side effects.	Known to cause depletion, contributing to neuropathy and other issues.
Effect on Folate	Limited or conflicting evidence for depletion during monotherapy. Supplementation still advised, especially during pregnancy.	Strong evidence for depletion due to metabolic interference, increasing birth defect risk.
Effect on Vitamin D	Possible risk of deficiency, especially in children, requiring monitoring.	Strong evidence for interference with vitamin D metabolism, increasing risk of bone softening (osteomalacia).
Effect on other vitamins	Generally considered to have fewer impacts, but individual variations exist.	Associated with depletion of various nutrients, including Biotin, Vitamin B12, and Vitamin E.
Overall Risk	Lower overall risk of widespread nutrient depletion compared to older AEDs.	Higher overall risk of multi-nutrient deficiencies due to enzyme-inducing properties.

Conclusion: A Nuanced Understanding

While Keppra is considered a modern antiepileptic drug with a more favorable side effect profile than older alternatives, it is not without nutritional considerations. The most prominent concern is the potential for Vitamin B6 depletion, which may contribute to mood-related side effects such as irritability and depression. While the evidence is less conclusive for widespread depletion of other vitamins like folate and Vitamin D, monitoring and sensible supplementation are prudent, especially for those on long-term therapy or with specific health needs, such as women of childbearing potential. Open communication with your healthcare provider is the most effective strategy to manage your health while on Keppra, including discussing any observed side effects and a personalized vitamin strategy. A balanced diet and targeted supplementation, under medical supervision, can help address these nutritional considerations and improve overall well-being while effectively managing epilepsy.

References

PeaceHealth Health Information Library. Levetiracetam – Health Information Library. PeaceHealth, 2024. https://www.peacehealth.org/medical-topics/id/hn-10001155

Han, Da Hee. Vitamin B6 May Help Treat Levetiracetam-Induced Behavioral Effects - MPR. MPR, 2017. [https://www.empr.com/home/mpr-first-report/aes-2017/vitamin-b6-may-help-treat-levetiracetam-induced-behavioral-effects/]

Frequently Asked Questions

Why does Keppra potentially cause Vitamin B6 deficiency?

The exact mechanism isn't fully understood, but it's believed that levetiracetam may interfere with the body's utilization of Vitamin B6. Since Vitamin B6 is crucial for synthesizing neurotransmitters like GABA and serotonin, its deficiency can lead to neuropsychiatric side effects, including mood changes.

How can I tell if my mood changes are related to a Keppra-induced Vitamin B6 deficiency?

It can be difficult to pinpoint the exact cause without medical evaluation. However, mood-related side effects like irritability, anxiety, or depression that coincide with starting or increasing Keppra could be an indicator. Blood tests can confirm a deficiency, and a doctor might suggest a trial of Vitamin B6 supplementation to see if symptoms improve.

Is it safe to take Vitamin B6 supplements with Keppra?

It is important to discuss Vitamin B6 supplementation with your doctor or pharmacist before starting. While supplementation can be helpful, high amounts of B6 can potentially affect the blood levels of some antiepileptic drugs, which could trigger seizures.

Do I need to take extra Vitamin D while on Keppra?

For individuals on long-term Keppra therapy, especially children or those with limited sun exposure, a doctor may recommend monitoring Vitamin D levels. If levels are low, supplementation may be necessary to prevent bone health issues.

Does Keppra deplete other vitamins besides B6 and D?

Compared to older AEDs, Keppra is less likely to cause widespread nutrient depletion. Some long-term anticonvulsant users may experience decreased levels of other nutrients like biotin and L-carnitine, but the direct link to Keppra is less certain. Monitoring and a balanced diet are key.

Should women of childbearing age on Keppra take folic acid?

For all women of childbearing potential taking antiepileptic drugs, including Keppra, standard recommendations suggest discussing folic acid supplementation with their doctor. This is primarily a preventative measure for neural tube defects, though Keppra is not strongly linked to folate deficiency.

Can diet help prevent vitamin depletion from Keppra?

Yes, maintaining a nutrient-dense and balanced diet is always beneficial. Including foods rich in B vitamins (like whole grains, meat, and vegetables) and Vitamin D (fatty fish, fortified milk) can help, but it may not be enough to prevent a deficiency entirely. A doctor may still recommend supplements.