Open AccessDiscontinuation of carbamazepine due to concerns of long‐term consequences of enzyme induction
Author(s) -
Mäkinen Jussi,
Rainesalo Sirpa,
Raitanen Jani,
Saarinen Jukka,
Sandell Satu,
Peltola Jukka
Publication year - 2018
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12227
Subject(s) - discontinuation , carbamazepine , medicine , sex hormone binding globulin , endocrinology , epilepsy , adverse effect , testosterone (patch) , gastroenterology , hormone , androgen , psychiatry
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.