Influence of antiepileptic drugs on serum lipid levels in adult epilepsy patients

The aim of this study was to evaluate the influence of antiepileptic drugs (AEDs) on lipid levels in adult epilepsy patients. We retrospectively reviewed blood data of 5053 patients with epilepsy (aged 20-94 years) and divided them into 3 groups: non AED group (without AED treatment), non-inducer group (using non-inducer AEDs), and inducer group (taking inducer AEDs; phenytoin (PHT), phenobarbital (PB), and carbamazepine (CBZ)). As a marker of dyslipidemia, the level of non-high-density lipoprotein cholesterol (non-HDL-C) was calculated by subtracting HDL-cholesterol from total cholesterol. The mean non-HDL-C level of non AED group, non-inducer group, and inducer group was 124, 130, and 138 mg/dL, respectively. In inducer group, patients using CBZ had a higher non-HDL-C level than patients taking PHT or PB. When a non-HDL-C level exceeding 180 mg/dL was defined as dyslipidemia, use of CBZ was associated with a significantly higher risk of dyslipidemia (adjusted odds ratio (OR); 2.6: 95% confidence interval (CI): 1.8-3.8) in comparison with non AED group. Use of valproic acid (VPA) was also associated with a higher non-HDL-C level (OR; 2.1: 95% CI: 1.4-3.2). An elevated non-HDL-C level was associated with increasing age, increasing BMI, and male gender, and use of inducers enhanced the risk of dyslipidemia. We recommend routine monitoring of the non-HDL-C level when using VPA and inducers, especially CBZ. While CBZ and VPA are first-line AEDs, medication should be selected by considering risk factors for dyslipidemia, such as age gender, and obesity.