Use of antiepileptic drugs and risk of hypothyroidism

Lai, Edward Chia Cheng; Yang, Yea Huei Kao; Lin, Shio Jean; Hsieh, Cheng Yang

doi:10.1002/pds.3498

Cited by 38 publications

(37 citation statements)

References 40 publications

(63 reference statements)

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“…PSSA has also been employed in previous studies investigating associations between use of certain target drugs and potential AEs such as depression [15], hip fracture [18], or nocturnal leg cramps [19]. The validity of the PSSA has been confirmed by previous study [20], [21].…”

Section: Methodsmentioning

confidence: 89%

“…Future cohort studies are necessary to accurately chronicle the exposure and outcome events in order to assess the impact of drug switching. Although one option to evaluate switching is to restrict the study subjects to only those without switching antipsychotics, as has been performed in a previous study [20], it is possible that such restriction might reduce sample size, statistical power, and generalizability of study results. We did not investigate the dose-response relationship between sulpiride and AEs in the study because only patients who had both the marker and index drugs were included in the analyses (case-only design).…”

Section: Discussionmentioning

confidence: 99%

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Detecting Potential Adverse Reactions of Sulpiride in Schizophrenic Patients by Prescription Sequence Symmetry Analysis

et al. 2014

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PurposePrevious studies have demonstrated sulpiride to be significantly more effective than haloperidol, risperidone and olanzapine in schizophrenic treatment; however, only limited information is available on the potential risks associated with sulpiride treatment. This study attempts to provide information on the potential risks of sulpiride treatment of schizophrenia, especially with regard to unexpected adverse effects.Materials and MethodsPatients with schizophrenia aged 18 and older, newly prescribed with a single antipsychotic medication from the National Health Insurance Research Database of Taiwan in the period from 2003 to 2010 were included. A within-subject comparison method, prescription sequence symmetry analysis (PSSA) was employed to efficiently identify potential causal relationships while controlling for potential selection bias.ResultsA total of 5,750 patients, with a mean age of 39, approximately half of whom were male, constituted the study cohort. The PSSA found that sulpiride was associated with EPS (adjusted SR, 1.73; 95% CI, 1.46–2.06) and hyperprolactinemia (12.04; 1.59–91.2). In comparison, EPS caused by haloperidol has a magnitude of 1.99 when analyzed with PSSA, and hyperprolactinemia caused by amisulpride has a magnitude of 8.05, respectively. Another finding was the unexpected increase in the use of stomatological corticosteroids, emollient laxatives, dermatological preparations of corticosteroids, quinolone antibacterials, and topical products for joint and muscular pain, after initiation of sulpiride treatment.ConclusionsWe found sulpiride to be associated with an increased risk of EPS and hyperprolactinemia, and the potential risk could be as high as that induced by haloperidol and amisulpride, respectively. Additionally, our study provides grounds for future investigations into the associations between sulpiride and the increased use of additional drugs for managing adverse effects, including stomatological, dermatological, and musculoskeletal or joint side effects, constipation, and pneumonia.

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Section: Methodsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Detecting Potential Adverse Reactions of Sulpiride in Schizophrenic Patients by Prescription Sequence Symmetry Analysis

et al. 2014

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“…32 It is therefore possible that CH caused by AED is already commonly treated with thyroxine. 32 It is therefore possible that CH caused by AED is already commonly treated with thyroxine.…”

Section: Discussionmentioning

confidence: 99%

Antiepileptic drugs are associated with central hypothyroidism

2018

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“…Despite the overlapping characteristics, and shared pharmacology of BD and epilepsy (52-55), we could only find literature on carbamazepine and oxcarbazepine associated with hypothyroidism in epilepsy, a disease in which the pathogenesis may involve thyroid hormones (56). Evidence from epilepsy studies shows adverse thyroid effects from valproate (51,(57)(58)(59), carbamazepine (51,57,59), and oxcarbazepine (51,59). Having similar mechanisms of action, both carbamazepine and oxcarbazepine see a reduction in T4, but little impact on thyroid-stimulating hormone (TSH), with the effects reversible with discontinuation of therapy (60).…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort

et al. 2016

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ObjectivesThyroid abnormalities in patients with bipolar disorder (BD) have been linked to lithium treatment for decades, yet other drugs have been less well studied. Our objective was to compare hypothyroidism risk for lithium versus the anticonvulsants and second‐generation antipsychotics commonly prescribed for BD.MethodsAdministrative claims data on 24,574 patients with BD were analyzed with competing risk survival analysis. Inclusion criteria were (i) one year of no prior hypothyroid diagnosis nor BD drug treatment, (ii) followed by at least one thyroid test during BD monotherapy on lithium carbonate, mood‐stabilizing anticonvulsants (lamotrigine, valproate, oxcarbazepine, or carbamazepine) or antipsychotics (aripiprazole, olanzapine, risperidone, or quetiapine). The outcome was cumulative incidence of hypothyroidism per drug, in the presence of the competing risk of ending monotherapy, adjusted for age, sex, physician visits, and thyroid tests.ResultsAdjusting for covariates, the four‐year cumulative risk of hypothyroidism for lithium (8.8%) was 1.39‐fold that of the lowest risk therapy, oxcarbazepine (6.3%). Lithium was non‐statistically significantly different from quetiapine. While lithium conferred a higher risk when compared to all other treatments combined as a group, hypothyroidism risk error bars overlapped for all drugs. Treatment (p = 3.86e‐3), age (p = 6.91e‐10), sex (p = 3.93e‐7), and thyroid testing (p = 2.79e‐87) affected risk. Patients taking lithium were tested for hypothyroidism 2.26–3.05 times more frequently than those on other treatments.ConclusionsThyroid abnormalities occur frequently in patients with BD regardless of treatment. Therefore, patients should be regularly tested for clinical or subclinical thyroid abnormalities on all therapies and treated as indicated to prevent adverse effects of hormone imbalances on mood.

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Use of antiepileptic drugs and risk of hypothyroidism

Abstract: The results indicated an increased risk of hypothyroidism among patients using AEDs, especially phenytoin, valproate, phenobarbital, carbamazepine, and oxcarbazepine. The findings also provided strong grounds for further investigations on acute thyroid adverse effect induced by phenytoin.

Cited by 38 publications

References 40 publications

Detecting Potential Adverse Reactions of Sulpiride in Schizophrenic Patients by Prescription Sequence Symmetry Analysis

Detecting Potential Adverse Reactions of Sulpiride in Schizophrenic Patients by Prescription Sequence Symmetry Analysis

Antiepileptic drugs are associated with central hypothyroidism

Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort

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