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Yıl:2011; Cilt: 48; Sayı: 1>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2011;48(1):11-16
Antiepileptik İlaçların Lipit Profili ve Karaciğer Enzimleri Üzerine Etkisi
N Bölükbaşı, F Akar, S Bir
Pamukkale Üniversitesi Tıp Fakültesi, Denizli
Amaç: Antiepileptik ilaçların lipit profilini ve karaciğer enzimlerini etkiledikleri gösterilmiştir. Ancak bu yayınlar enzim inhibisyonu veya indüksiyonu yapan eski antiepileptiklerle yapılmış çalışmalardır. Yeni nesil antiepileptik ilaçlarla bu konularda yapılan çalışmalar sınırlı sayıdadır. Oysa son yıllarda yan etkilerinin ve ilaç etkileşimlerinin daha az olması sebebiyle tercih edilen yeni nesil antiepileptikleri llanan hasta sayısı giderek artmaktadır. Bu çalışmada eski (karbamazepin ve valproik asit) ve yeni nesil antiepileptiklerin (okskarbazepin, levetirasetam, topiramat) lipit profiline ve karaciğer enzimlerine etkilerinin değerlendirilmesi amaçlanmıştır. Yöntemler: Parsiyel epilepsi tanısıyla izlenen, en az 1 yıldır tek tip antiepileptik ilaç kullanan (karbamazepin (n=15), valproik asit (n=15), topiramat (n=9), levetirasetam (n=9) ve okskarbazepin (n=15)) toplam 63 epileptik hastaçalışmaya alınmış, sağlıklı kontrol grubu (n=15) ve epileptik kontrol grubu (n=15) oluşturulmuştur. Bulgular: Sağlıklı ve epileptik kontrol grupları karşılaştırıldığında epileptik kontrol grubunda trigliserit, VLDL yüksek, AST (p<0.05) düşük olduğu saptanmıştır. Sağlıklı kontrol grubuyla karşılaştırıldığında; karbamazepin grubunda TC (total kolesterol) ve TC-HDL yüksek (p<0.05), valproik asit grubunda AST ve ALT düşük (p<0.05), okskarbazepin grubunda TC yüksek (p<0.05), levetirasetam grubunda TC ve TC-HDL yüksek, topiramat grubunda AST düşük (p<0.005) olduğu belirlenmiştir. Epileptik kontrol grubu ile karşılaştırıldığında karbamazepin grubunda HDL yüksek (p<0.05), okskarbazepin grubunda HDL ve AST yüksek (p<0.05), topiramat grubunda trigliserit düşük, HDL yüksek (p<0.05) olduğu, valproik asit ve levetirasetam gruplarında ise istatistiksel olarak anlamlı fark olmadığı tespit edilmiştir. Sonuç: Çalışmamızda elde ettiğimiz bulgulara göre yeni nesil antiepileptikler genel olarak; karaciğer enzimleri üzerinde olumsuz etkiye sahip değilken, topiramat lipit profili üzerinde ateroskleroza karşı koruyucu etkiler göstermekte ve literatürde koroner kalp hastalarında tercih edilebileceğini gösteren bulguları desteklemektedir.
The Effects of Antiepileptic Drugs on Lipid Profiles and Liver Enzymes
Objective: The effects of antiepileptic drugs on lipid profiles and liver enzymes have been well verified in studies that were, however, performed on old antiepileptic drugs, which were enzyme inhibitors and inductors. There are very limited studies of new antiepileptic drug to this date. In this study, antiepileptics such as valproic acid and carbamazepine were compared with the new ones, e.g. oxcarbazepine, levetiracetam and topiramate for the effects on lipid profiles and liver enzymes. Methods: In this study, we recruited a total of 63 patients with partial epilepsy who were on monotherapy for at least one [year] and divided them into different drug groups-carbamazepine (n=15), valporic acid (n=15), oxcarbazepine (n=9), levetirasetam (n=9), and topiramate (n=9). Two control groups, healthy control (n=15) and epileptic control (n=15), were constituted. Results: The results of healthy controls and epileptic controls were compared. Serum triglyceride and VLDL levels were high, levels of AST were low (p<0.05) in the epileptic controls. Carbamazepin group had higher total cholesterol (TC) and TC-HDL (p<0.05), valproic acid group had lower AST and ALT levels (p<0.05), oxcarbazepine group had higher TC, levetiracetam group had higher TC and TC-HDL (p<0.05), and the topiramate group had lower levels of AST (p<0.05) in comparison with the healthy controls. The topiramate group had lower triglyceride and higher HDL levels (p<0.05) than the epileptic controls. Conclusion: The results of our study suggest that the new antiepileptic drugs have no negative effects on liver enzymes and that topiramate has protective effects on lipid profile against atherosclerosis and, support the literature-reported findings demonstrating that topiramate may be a drug of choice in cases of patients with coronary disease.

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