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.


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