SERUM CARBAMAZEPINE CONCENTRATIONS AND THEIR ASSOCIATION WITH BIOCHEMICAL, METABOLIC, AND HEMATOLOGICAL CHANGES IN ADULT EPILEPTIC PATIENTS

Abstract

Background: Carbamazepine (CBZ) is one of the most commonly prescribed first-line antiepileptic drugs for the management of focal and generalized tonic–clonic seizures. However, prolonged CBZ therapy is known to cause hepatic, metabolic, and hematological disturbances, primarily due to hepatic enzyme induction and increased oxidative stress. Objectives: To assess biochemical, metabolic, and hematological alterations in adult epileptic patients receiving CBZ monotherapy and to evaluate their correlation with serum CBZ concentrations. Methods: This cross-sectional study included 96 adult patients with epilepsy (aged 16–72 years) receiving CBZ monotherapy at doses ranging from 300–800 mg/day for a minimum duration of 15 days. Serum CBZ concentrations were estimated using high-performance liquid chromatography (HPLC). Biochemical parameters (liver function tests, renal profile, lipid profile, and electrolytes) and hematological indices (hemoglobin, leukocyte count, and platelet count) were analyzed. Based on serum CBZ levels, patients were categorized into subtherapeutic (<4 mg/L), therapeutic (4–12 mg/L), and supratherapeutic (>12 mg/L) groups. Statistical analysis was performed using one-way ANOVA and Pearson’s correlation, with p < 0.05 considered statistically significant. Results: Patients with supratherapeutic CBZ levels demonstrated significantly elevated liver enzymes (AST, ALT, ALP), total bilirubin, total cholesterol, triglycerides, and LDL cholesterol (p < 0.05). In contrast, hemoglobin levels, total leukocyte count, platelet count, and serum sodium levels showed a significant decline with increasing CBZ concentrations (p < 0.05). Pearson’s correlation analysis revealed positive correlations between serum CBZ levels and hepatic and lipid parameters, while negative correlations were observed with hematological indices and serum sodium levels. Conclusion: Chronic CBZ therapy is associated with significant biochemical and hematological alterations, particularly at supratherapeutic concentrations. Regular biochemical surveillance in conjunction with therapeutic drug monitoring is essential to optimize efficacy, detect early toxicity, and individualize CBZ dosing in patients with epilepsy.