UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Meningitis? Check the medication list!

Keywords: aseptic meningitis,antibiotics,sulfamethoxazole,valacyclovir,antiepileptics,levetiracetam (PubMed Search)

Posted: 3/6/2014 by Ellen Lemkin, MD, PharmD
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Aseptic meningitis is meningitis with negative bacterial cultures. Overall, viral infections are the most common etiology, however medications can also cause this illness.

Well known causes of aseptic meningitis include: antimicrobials (particularly sulfamethoxazole/trimethoprim), NSAIDS, antivirals (valacyclovir), and antiepileptics.

Recently an abstract was published that suggests that patients on levetiracetam have a higher risk of developing aseptic meningitis than those on topiramate and gabapentin. Lamotrigine has also been implicated, but appears to have a lower risk than levetiracetam, topiramate and gabapentin.

References

Teigland C, Chen P, Parente A, Bhattacharjee R. FDA Black Box Warning on Risk of Aseptic Meningitis with Use of Antiepileptic Drug Lamotrigine: Comparative Risk of Alternative Medications. Abstract, American Epilepsy Society. 2013

http://www.aesnet.org/go/publications/aes-abstracts/abstract-search/mode/display/st/parente/sy/2013/sb/Authors/id/1751398