Effect of Carbamazepine and Sodium Valproate on Liver Enzymes of Epileptic Children

Carbamazepine and sodium valproate are one of the most common antiepileptic medications used in clinical practice. The period of treatment is commonly associated with benign alternation of the liver enzymes due to drug metabolism. Evaluation of asymptomatic enzymatic changes could be challenging to the expert clinician and may expose patients to unnecessary procedures or expenses. Thus, this article aims to focus on the frequency of liver enzyme abnormalities among epileptic children. For this, an analytic cross-sectional study was conducted in 100 epileptic patients who received carbamazepine or sodium valproate for 1 year. Those with healthy pretreatment liver enzymes were recruited for the study. The results showed an elevation of Aspartate Aminotransferase (AST) in 24% of the patients treated with sodium valproate (p = 0.01) and 20% of the patients treated with carbamazepine. Alanine Aminotransferase (ALT) was elevated in both groups to a similar extent, 6% (p = 0.01). In conclusion, the study showed a lower proportion of liver enzyme abnormalities, since AST is a less sensitive biomarker when compared to ALT. No measurement exceeds twice the average value, nor are there any clinical abnormalities. There is no proven value of routine liver enzyme measurement in asymptomatic patients in our study. However, baseline enzyme tests are recommended. Further controlled studies on a larger sample size are required.