Blog #177: Heart Attacks, Strokes and Cardiovascular Dangers from Some Epilepsy Drugs

 

 

If your seizure control is not satisfactory, and if you and your doctor are trying different antiepileptic drugs (AED), be aware that some side-effects can be more common with certain AEDs and less with others. Your choice could be beneficial for you. This topic was reviewed by Mary Beth Nierengarten in the November 21, 2024, issue of Neurology Today page 9. Older adults with epilepsy are much more likely to experience new cardiovascular events, including strokes, transient ischemic events (TIA) and heart attacks if they take the enzyme-inducing antiepileptic drugs.¹

Enzyme-inducing antiepileptic drugs (EIAEDs) are a class of medications used to manage seizures. They have the effect of increasing the activity of certain liver enzymes, primarily the cytochrome P450 (CYP450) family. How Enzyme Induction Works:

•    EIAEDs, the enzyme-inducing drugs, stimulate the production of CYP450 enzymes in the liver.

•    These enzymes are responsible for metabolizing (breaking down) many drugs and other substances in the body. Carbamazepine (Tegretol), Phenytoin (Dilantin), Phenobarbital (Luminal)and Primidone (Mysoline) are the classical enzyme-inducing antiseizure drugs (ASDs). Non-enzyme-inducing ASDs include Levetiracetam (Keppra), Lamotrigine (Lamictal), Lacosamide (Vimpat). The EIAEDs were used in a third of those with the increased risk and this Canadian study (reference 1) highlights the risk of long-term use of these medications for epilepsy. Co-morbidities with other medical diseases, especially cardiovascular risks, should be considered when choosing among 25 commonly used AEDs.

Those patients studied ranged in age from 62 to 85. Most were white. males and females of comparable numbers. None in the study had had a previous reported stroke, transient ischemic attack (TIA) or heart attack but the study showed 24.6% of the enzyme-inducing ASMs were then associated with new-onset cardiovascular events. Consider these findings, if possible, with your doctor when choosing your first-line therapy, avoiding Tegretol, Dilantin, Phenobarbital, and Primidone. If you have cardiovascular symptoms and risks, consider an EIAED as Levetiracetam (Keppra), Lamotrigine (Lamictal) or Lacosamide (Vimpat). Other common AED adverse effects, e.g. balance and cognition problems, should also be discussed with your physician.

We need to take a comprehensive approach for long-term outcomes for patients with epilepsy as most patients with epilepsy will be on these medications for decades or life-long.

 

1.    Li J, Shlobin NA, Thijs RD, et al. Antiseizure medications and cardiovascular events in older people with epilepsy. JAMA Neurol 2024; Epub 2024 Sept 30.

 

Lance Fogan, M.D., is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

  and is now available in eBook, audiobook, soft and hard cover editions.