Minimizing drug-drug interactions between dabigatran and levetiracetam through clinical management. a case report

Background Direct oral anticoagulants (DOACs) are useful for stroke prevention in atrial fibrillation (AF) patients. However, the concomitant administration of Levetiracetam limited their use in clinical practice, although some authors raise doubts about clinical relevance of the interaction. Case summary We report a case of a 54-year-old male with AF, cirrhosis and seizures, in which the assessment of Dabigatran plasma concentration was needed due to the concomitant use of Levetiracetam. In this case no relevant reduction of trough Dabigatran plasma concentration was found. An increased peak serum level of dabigatran may be obtained delaying levetiracetam administration. The patient was then followed in our clinic and during 32 months of follow up no ischemic or haemorrhagic events occurred. Discussion The evaluation of DOACs concentration could be helpful to start a tailored therapy in frailty patients.