Enzyme-inducing antiepileptic drugs can lead to a significant fall in serum cholesterol and c-reactive protein levels. Patients treated with the older drugs such as, phenytoin and carbamazepine, tend to have higher serum cholesterol levels. Dr. Scott Mintzner reported at the annual Am. Epilepsy Society meeting that the drug treatment with the older drugs was linked to roughly a 50% increased risk for a cardiovascular event, based on rates reported for increased stroke risk. Carbamazepine and phenytoin, which induce hepatic, cytochrome P450 enzymes, may not be the best alternative for patients long-term.

Enzyme-inducing antiepileptic drugs may be more advantageous in reducing serum levels of Vitamin D and testosterone. Hepatic enzymes induced by the older antiepileptics speed the metabolism of statins and block their effect. The biggest effect was noted in drops in non-high density lipoproteins. The impact of antiepileptic drugs on CRP has not been established.

It is important to consider the effects of the newer vs. older antiepileptics on cholesterol levels. The wide variation in patient response to anti-epileptic medications warrants neurology consultation