Lipoprotein(a) Concentration Increases during Treatment with Carbamazepine

Abstract

Summary:Purpose: Treatment with carbamazepine (CBZ) is known to affect apolipoprotein B-containing lipoprotein concentrations in serum. However, little is known about the effects of anticonvulsant drugs (AEDs) on lipoprotein(a) [Lp(a)], although Lp(a) has been characterized as independent cardiovascular risk factor. We investigated prospectively the effect of CBZ on lipoprotein(a) concentration in normolipidemic healthy adults.Methods: Twenty male volunteers were included in the study. Lp(a) levels were determined before and 69 ± 19 days after CBZ administration by using an enzyme-linked immunoassay.Results: CBZ (mean plasma concentration, 6.6 ± 0.6 g/ml)caused a significant increase in Lp(a) concentrations, with a median change of +19.5% (95% CI: +8.2, +53.3; p < 0.001). Total cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides also increased significantly. Conclusions:Although the precise mechanism of action of CBZ on Lp(a) elevation remains uncertain, it might be related to its enzyme-inducing properties. During treatment with CBZ, special focus should be given to elevated LDL cholesterol and Lp(a) concentrations with regard to increased risk for atherosclerotic vascular diseases.

Evaluation of Effect of Antiepileptic Drugs on Serum Lipid Profile among Young Adults with Epilepsy in a Tertiary Care Hospital in Pondicherry

“…These findings are largely consistent with and significantly extend those of other investigations. Studies of carbamazepine treated patients have mostly demonstrated increased TC levels compared with a control group, with most also showing increased LDL-C and HDL-C in this population [11][12][13][14][15]. However, in our study we did not observe any statistically significant difference among mean LDL-C levels which is similar to study conducted by Yi U et al, [16].…”

Conversion from enzyme-inducing antiepileptic drugs to topiramate: Effects on lipids and c-reactive protein

“…Patients switched from the enzyme-inducing agents phenytoin (PHT) or carbamazepine (CBZ) to the non-inducing drugs levetiracetam (LEV) or lamotrigine (LTG) experience a sizable drop in serum lipids, along with changes in other serologic indices of vascular risk, including C-reactive protein (CRP) (Mintzer et al, 2009). Other studies have suggested that patients treated with PHT or CBZ may have higher lipid levels than controls; at least one such study measured before and after treatment and found that CBZ produced significant elevation of lipids (Bramswig et al, 2003;Nikolaos et al, 2004). Furthermore, the potent CYP450 inhibitor ketoconazole has been shown to reduce cholesterol production in experimental animals (Gibbons, 2002), and this effect is corroborated clinically by the finding that patients taking valproate, an AED with CYP450-inhibiting properties, have lower cholesterol levels than controls (Nikolaos et al, 2004).…”

Partners against Mortality in Epilepsy Conference Summary

“…Because of the cross-sectional design of these studies, the cholesterol increase cannot be definitively ascribed to AEDs. However, there have been a number of studies that measured lipids before and after carbamazepine treatment (31). These studies have shown increases in total cholesterol of 20 to 25 mg/dL.…”