Hepatic enzymes' level during chronic use of anticonvulsant drugs

Hoshino, Maurício; Heise, Carlos Otto; Puglia, Paulo; Almeida, Arlete B.B.; Cukiert, Arthur

doi:10.1590/s0004-282x1995000500001

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…The frequency of elevated GGT has been widely reported to be 34%-100% in patients undergoing CBZ treatment [11][12][13]. Strolin et al [10] reported that increase in serum GGT was generally observed in 75%-95% of patients treated chronically with enzymeinducing agents.…”

Section: Discussionmentioning

confidence: 99%

Effects of antiepileptic monotherapy on hematological and biochemical parameters

Yoshimura

Hara

Akaza

et al. 2019

E&S

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Sever e cytopenia and liver dysfunction ar e char acter ized as antiepileptic dr ug (AED) adverse effects dependent upon an idiosyncrasy. However, in clinical practice, we often find hematological and biochemical changes during AED treatment with causes other than an idiosyncrasy. This study aims to investigate the effect of antiepileptic monotherapy on hematological and biochemical parameters. Methods: We r etr ospectively r ecr uited 480 patients untr eated with AED at baseline. Changes in hematological and biochemical parameters before and after initiation of medication were investigated, and correlation with plasma concentrations of AED was analyzed. Results: Sixty-six of 480 patients treated with carbamazepine (CBZ: n = 27), sodium valproate (VPA: n = 19) or levetiracetam (LEV: n = 20) monotherapy were eventually selected for analysis. After CBZ treatment, decreased white blood cell (WBC) count and increased gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) activities were recorded at high frequencies. Decreased WBC count tended to correlate with elevated serum CBZ level. Elevated GGT activity was observed in all patients treated with CBZ. In patients treated with VPA, platelet (PLT) counts decreased. In patients treated with LEV, there were no significant differences in the measured parameters before and after medication. Discussion: We consider ed that the r eduction in WBC count might be dose-dependently related to AEDs. Elevated GGT activity was observed in all patients treated with CBZ, but the average increase in GGT activity was 35.19 ± 33.08 U/L. In patients undergoing VPA treatment, decreased PLT counts were also observed at high frequency. Thus, hematological and biochemical parameters should be closely monitored in patients receiving AED, especially in patients treated with high doses of AEDs.

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Section: Discussionmentioning

confidence: 99%

Effects of antiepileptic monotherapy on hematological and biochemical parameters

Yoshimura

Hara

Akaza

et al. 2019

E&S

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“…Therefore, it may not be necessary to pursue extensive evaluation for all abnormal results, as this would expose many children to unnecessary procedures and expenses [26]. Regular clinical assessment besides patients and family education can play an essential role in detecting early hepatic injuries.…”

Section: Discussionmentioning

confidence: 99%

Effect of Carbamazepine and Sodium Valproate on Liver Enzymes of Epileptic Children

Mahgoub¹,

Abdoun²,

Azam³

et al. 2020

DSAHMJ

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Carbamazepine and sodium valproate are one of the most common antiepileptic medications used in clinical practice. The period of treatment is commonly associated with benign alternation of the liver enzymes due to drug metabolism. Evaluation of asymptomatic enzymatic changes could be challenging to the expert clinician and may expose patients to unnecessary procedures or expenses. Thus, this article aims to focus on the frequency of liver enzyme abnormalities among epileptic children. For this, an analytic cross-sectional study was conducted in 100 epileptic patients who received carbamazepine or sodium valproate for 1 year. Those with healthy pretreatment liver enzymes were recruited for the study. The results showed an elevation of Aspartate Aminotransferase (AST) in 24% of the patients treated with sodium valproate (p = 0.01) and 20% of the patients treated with carbamazepine. Alanine Aminotransferase (ALT) was elevated in both groups to a similar extent, 6% (p = 0.01). In conclusion, the study showed a lower proportion of liver enzyme abnormalities, since AST is a less sensitive biomarker when compared to ALT. No measurement exceeds twice the average value, nor are there any clinical abnormalities. There is no proven value of routine liver enzyme measurement in asymptomatic patients in our study. However, baseline enzyme tests are recommended. Further controlled studies on a larger sample size are required.

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“…The use of AEDs induces hepatotoxic reactions, from mild and transient elevations of hepatic enzymes to fatal hepatic failure which are associated with mortality and morbidity. 6,7 Since, liver enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT)serve as markers of hepatocellular injury and are elevated in various forms of liver diseases. However, an elevation of these enzymes can also be due to secondary reasons, without the involvement of hepatic pathology.…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Anticonvulsants on Liver Enzyme Activities in Patients With Seizure Disorder

Dhungana

Pandeya

Shakya

et al. 2022

JCMC

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Background: Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures, which has transient signs and/or symptoms of abnormal, synchronous neuronal activity in the brain. Antiepileptic drugs (AEDs) used for the prevention of seizure have been found to be an inducer of liver enzyme activity. So, the purpose of this study was to see the effect of antiepileptic drugs on hepatic enzymes activity. Methods: An observational study was carried out in Kathmandu Medical College from October 2020 to April 2021 at neurology department. Sixty-seven seizure patients aged 19-89 years were included in the study. Liver function test was performed before medication, followed up and monitored for three and six months. Paired sample t-test was used to compare the means by using SPSS version 15. Results: Among carbamazepine (CBZ) and sodium valproate (VPA) treated cases, 4.5% and 9.1% respectively showed raised Alanine aminotransferase (ALT) activity whereas, 13.6% and 4.5% respectively showed raised Alkaline Phosphatase (ALP) activity. ALT activity was higher in VPA treated patient compared to CBZ treated patient. However, ALP activity was raised in CBZ treated patient compared to VPA treated patients. No, change in liver enzyme activities was observed in patient treated with Levetiracetam Conclusions: Anticonvulsant drugs used during the treatment have mild to moderate hepatotoxicity. Liver enzyme activity more than two to three-fold may increase. Levetiracetam has minimal hepatic metabolism while sodium valproate is more hepatotoxic. Therefore, routine screening of hepatic enzymes is recommended to the patients under antiepileptic therapy.

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Hepatic enzymes' level during chronic use of anticonvulsant drugs

Cited by 5 publications

References 21 publications

Effects of antiepileptic monotherapy on hematological and biochemical parameters

Effects of antiepileptic monotherapy on hematological and biochemical parameters

Effect of Carbamazepine and Sodium Valproate on Liver Enzymes of Epileptic Children

Effect of Different Anticonvulsants on Liver Enzyme Activities in Patients With Seizure Disorder

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