Antiepileptic drug use for treatment of epilepsy and dyslipidemia: Systematic review

Summary Objective To characterize the association between commonly used anti-epileptic drugs (AEDs) and plasma lipid levels in patients with epilepsy. Methods We sought observational studies that reported association between commonly used AEDs and plasma lipid levels in patients. The primary outcome was low-density lipoprotein (LDL) cholesterol. High-density lipoprotein (HDL), total cholesterol and triglyceride were secondary outcomes. The control group included healthy controls, pre-treatment patients or patients treated with other AEDs. We conducted a systematic search of major bibliographic databases and review of reference lists of primary articles and reviews. Primary comparisons of interest were: AED monotherapy vs. no AED use, monotherapy with one AED vs. other AED, and AED polytherapy vs. no AED use. Results 31 studies in 4126 people were identified. Carbamazepine, phenytoin and valproic acid were the most commonly studied drugs and were also implicated in causing considerable changes in plasma lipid levels in treated patients. There was an increase in LDL and total cholesterol levels with use of these three drugs; however, carbamazepine and phenytoin were also associated with higher levels of HDL. We could not identify one particular AED which was worse than the other in head-to-head comparison. We were unable to identify a particular polytherapy regimen that was worse than others. Conclusion We found evidence to suggest that some AEDs may negatively alter lipids levels in patients with epilepsy. Both treating physicians and people with epilepsy need to be vigilant in managing their vascular risk factors to avoid vascular disease.