Effects of long‐term treatment with antiepileptic drugs on serum lipid levels in children with epilepsy

Abstract

We determined serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglycerides (TGs) in 125 healthy children and in 119 children with epilepsy who had been receiving carbamazepine (58 children), phenobarbital (22 children), or valproic acid (39 children) for 7 months to 10.5 years (mean, 5.8 years). None of the variables considered was significantly correlated with time elapsed since start of treatment or with drug concentration in serum. In the groups receiving carbamazepine or phenobarbital, mean TC, HDL-C, and LDL-C levels were higher than in the control group, the differences being statistically significant for all except LDL-C in the phenobarbital group. In neither group did mean TC/HDL-C ratio or mean LDL-C/HDL-C ratio differ significantly from the corresponding control-group mean. In the group receiving valproic acid, mean TC level, mean LDL-C level, mean TC/HDL-C ratio, and mean LDL-C/HDL-C ratio were significantly lower than in the control group. In none of the treated groups did mean VLDL-C or TG level differ significantly from the corresponding control-group mean. Our results suggest, in contrast to previous reports, that the effects on the serum lipid profile of long-term treatment with hepatic-enzyme-inducing antiepileptic drugs (such as carbamazepine and phenobarbital) are probably not beneficial as regards risk of atherosclerosis-related disease. Our results additionally suggest a need for careful monitoring of serum cholesterol levels in children with epilepsy receiving carbamazepine or phenobarbital.

Regulatory network of lipid-sensing nuclear receptors: roles for CAR, PXR, LXR, and FXR

“…see refs. [131][132][133][134][135][136]) whereas other studies failed to detect a significant correlation between phenobarbital treatment and changes in lipid levels (e.g. see ref.…”

The High Atherosclerotic Risk Among Epileptics: the Atheroprotective Role of Multivitamins

“…In contrast, few studies reported that CBZ therapy does not affect serum lipids (TG, TC, HDL-c, LDL-c, and VLDL-c) (113). Lower values of TC, TG, HDL-c, and LDL-c similar to healthy controls have been found in epileptic patients receiving VPA, a well-known enzyme inhibitor (6,110). Gender difference has been demonstrated with significant increase of HDL among women and higher LDL-c and TG but lower HDL-c in men that are independent to the dose or plasma concentrations of CBZ.…”

“…The tendency to have recurrent, unprovoked seizures occurs with a prevalence of about 0.5% and a cumulative lifetime prevalence of 3% (1). Many studies have demonstrated that prolonged treatment with antiepileptic drugs (AEDs) could have some undesirable metabolic side effects including elevated plasma concentration of homocysteine (Hcy) (2 -4) and altered serum levels of cholesterol, lipoproteins (5,6), and uric acid (7). These findings have important clinical relevance to vascular endothelial dysfunction and atherosclerosis-related diseases.…”

“…Previous studies have demonstrated the influence of long-term antiepileptic therapy on the lipid profile of epileptics, particularly on apolipoprotein (Apo) serum levels (5,6,22). Hypercholesterolemia and dyslipidemia have long been known as important risks for atherosclerosis.…”

Hyperlipidemia Due to Rectal Phenobarbital Use: Case Report

“…Phenobarbital is an antiepileptic known to induce hepatic microsomal enzymes. Microsomal enzyme induction with exogenous drugs can alter the metabolism of bile acids, bilirubin, total cholesterol (TC), triglyceride (TG), and other endogenous molecules [1,2]. A 10-month-old infant presented with hyperlipidemia due to rectal phenobarbital-paracetamol combination (Paranox ® ), which was used by the parents to reduce fever related to enterovirus infection.…”