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Summary   Objective  Treatment with carbamazepine ( CBZ ), a potent enzyme inducer, is known to affect the lipid profile, steroid, and vitamin D metabolism. Consequently, it has been postulated that patients on  CBZ  should be switched to noninducing antiepileptic drugs ( AED s). However, little is known about the seizure outcome following a  CBZ  switch in seizure‐free patients. We aimed to address this issue using a controlled observational study design.    Methods  Fifty‐eight patients taking  CBZ  for focal epilepsy were assessed for discontinuing  CBZ  treatment due to concerns of long‐term adverse‐effects; 34 discontinued its therapy and 24 continued with  CBZ . Six‐month seizure freedom was the primary end point. Furthermore, serum samples (total cholesterol ( TC ), low‐density lipoprotein ( LDL ), high‐density lipoprotein ( HDL ), triglycerides, sex hormone–binding globulin ( SHBG ), free testosterone, and 25‐hydroxyvitamin D levels from before and at least 3 months after discontinuation or continuation were obtained from all patients.    Results  Seizure‐free patients had a 5‐fold elevated odds of seizure recurrence if  CBZ  was discontinued (95% confidence interval [ CI  0.51–49.3; p = 0.17). A significant decrease in serum levels of  TC ,  LDL ,  HDL , and  SHBG  as well as a significant increase in that of free testosterone were found in the discontinuation group compared with those who continued  CBZ . Nonsignificant changes in triglycerides and vitamin D levels were detected.    Significance  Discontinuation of  CBZ  in seizure‐free patients seems to carry a moderate, but legitimate, risk of relapse. Conversely, our results indicate that  CBZ  might have unfavorable effects on serum levels of  TC ,  LDL ,  HDL ,  SHBG , and free testosterone.

Discontinuation of carbamazepine due to concerns of long‐term consequences of enzyme induction