Document Detail


Conversion from enzyme-inducing antiepileptic drugs to topiramate: effects on lipids and C-reactive protein.
MedLine Citation:
PMID:  22119637     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We previously demonstrated that converting patients from the enzyme-inducers phenytoin or carbamazepine to the non-inducers levetiracetam or lamotrigine reduces serum lipids and C-reactive protein (CRP). We sought to determine if the same changes would occur when patients were switched to topiramate, which has shown some evidence of enzyme induction at high doses. We also examined the effects of drug switch on low-density lipoprotein (LDL) particle concentration.
METHODS: We converted 13 patients from phenytoin or carbamazepine monotherapy to topiramate monotherapy (most at doses of 100-150 mg/day). Fasting lipids, including LDL particle concentration, and CRP were obtained before and ≥6 weeks after the switch. A group of normal subjects had the same serial serologic measurements to serve as controls.
RESULTS: Conversion from inducers to topiramate resulted in a -35 mg/dL decline in total cholesterol (p=0.033), with significant decreases in all cholesterol fractions, triglycerides, and LDL particle concentration (p≤0.03 for all), as well as a decrease of over 50% in serum CRP (p<0.001). Alterations in cholesterol fractions and CRP remained significant when compared to those seen in normal controls.
CONCLUSIONS: Changes seen when inducer-treated patients are converted to TPM closely mimic those seen when inducer-treated patients are converted to lamotrigine or levetiracetam. These findings provide evidence that CYP450 induction elevates CRP and serum lipids, including LDL particles, and that these effects are reversible upon deinduction. Low-dose TPM appears not to induce the enzymes involved in cholesterol synthesis.
Authors:
Scott Mintzer; Christopher T Skidmore; Sara J Rankin; Inna Chervoneva; Edward Pequinot; David M Capuzzi; Michael R Sperling
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-11-25
Journal Detail:
Title:  Epilepsy research     Volume:  98     ISSN:  1872-6844     ISO Abbreviation:  Epilepsy Res.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-19     Completed Date:  2012-07-19     Revised Date:  2013-08-21    
Medline Journal Info:
Nlm Unique ID:  8703089     Medline TA:  Epilepsy Res     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  88-93     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier B.V. All rights reserved.
Affiliation:
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadephia, PA, United States. scott.mintzer@jefferson.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticonvulsants / therapeutic use*
C-Reactive Protein / metabolism*
Carbamazepine / therapeutic use*
Epilepsy / drug therapy*,  metabolism
Female
Fructose / analogs & derivatives*,  therapeutic use
Humans
Lipids / blood*
Lipoproteins, LDL / blood
Male
Middle Aged
Phenytoin / therapeutic use*
Chemical
Reg. No./Substance:
0/Anticonvulsants; 0/Lipids; 0/Lipoproteins, LDL; 0H73WJJ391/topiramate; 298-46-4/Carbamazepine; 30237-26-4/Fructose; 57-41-0/Phenytoin; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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