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Switching Anticonvulsant Drugs Cuts Cardiovascular Risk

Epilepsy patients reduce blood lipid levels with lamotrigine or levetiracetam

TUESDAY, March 24 (HealthDay News) -- Switching to anticonvulsant drugs that don't activate cytochrome P450 enzymes can improve blood cholesterol levels and lower cardiovascular risk in epilepsy patients, according to research published online March 18 in the Annals of Neurology.

Scott Mintzer, M.D., of Thomas Jefferson University in Philadelphia, and colleagues recruited 34 epilepsy patients who were being treated with either carbamazepine (CBZ) or phenytoin (PHT), two drugs that are known to induce cytochrome P450 activity that increases cholesterol level. Blood tests were taken before the study group switched to either lamotrigine (LTG) or levetiracetam (LEV), two non-inducing anticonvulsants. Blood tests were taken again six weeks after the switch. For comparison, the same blood tests were performed on 16 normal subjects not taking anticonvulsants who were age- and sex-matched to the study group.

At six weeks, the researchers found significant declines in the epilepsy patients in total cholesterol (-24.8 mg/dL), non-high-density lipoprotein (-19.9 mg/dL), triglycerides (-47.1 mg/dL) and C-reactive protein (-31.4 percent). Patients who went off CBZ also had a 31.2 percent decline in lipoprotein(a), while those taken off PHT had a lower homocysteine level (-1.7 μmol/L). Results were similar whether switched to LTG or LEV, the report indicates.

"As a consequence, we believe that the constellation of metabolic findings from our investigation and others casts significant doubt on the use of CBZ and PHT as first-line agents for the long-term treatment of epilepsy, and we suggest that it might be prudent for those who treat seizures to eschew their use in favor of other agents," the authors write.

Several authors of this article are promotional speakers for UCB Pharma or GlaxoSmithKline, the companies that manufacture levetiracetam and lamotrigine, respectively.

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