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Some anticonvulsant drugs significantly reduce vitamin D levels – many studies

Impact of carbamazepine on vitamin D levels: A meta-analysis - Nov 2021

Epilepsy Res. 2021 Nov 26;178:106829. doi: 10.1016/j.eplepsyres.2021.106829
Carla LoPinto-Khoury 1, Laura Brennan 2, Scott Mintzer 3

Purpose: There are longstanding concerns about the impact of enzyme-inducing anti-seizure medications (ASMs) on vitamin D, an important molecule in both bone metabolism and inflammation pathways. The relationship between chronic use of carbamazepine and vitamin D levels has been studied, but no comprehensive review to inform practitioners and policymakers is currently available. We performed a meta-analysis on studies that measured 25-hydroxyvitamin D (25OHD) levels in persons taking carbamazepine to determine whether this drug significantly reduces circulating 25OHD.

Principal results: From a literature search of the terms "carbamazepine" and "vitamin D", we identified 12 studies that measured 25OHD levels in persons on carbamazepine monotherapy groups and controls. Persons taking carbamazepine had significantly lower 25OHD levels than persons not taking carbamazepine. The average 25OHD levels of carbamazepine-treated patients across all studies was 21.8 ng/mL (IQR 15.4,26.0) whereas 25OHD levels of control subjects was 28.0 ng/mL (IQR 20.8,30.4). The weighted difference of means was 4.00 ng/mL of 25OHD. Neither age nor sex nor duration of carbamazepine therapy had a significant impact on this finding. The effect was similar irrespective of whether the comparator group consisted of healthy controls or epilepsy patients taking non-inducing medications.

Major conclusions: Carbamazepine use is associated with a reduction of 25OHD levels. In combination with other literature establishing the problematic metabolic effects of carbamazepine, this meta-analysis provides additional evidence in favor of the use of alternative ASMs as first-line agents. At minimum, vitamin D supplementation should be strongly considered for patients prescribed carbamazepine.

Vitamin D status among children and adolescents on anticonvulsant drugs in southern Switzerland.- 2014

Swiss Med Wkly. 2014 Aug 13;144:w13996. doi: 10.4414/smw.2014.13996. eCollection 2014.
Ramelli V1, Ramelli GP1, Lava SA2, Siegenthaler GM1, Cantù M3, Bianchetti MG1, Ceschi A4.

It is recognised that vitamin D status is often inadequate (<50 nmol/l) in epileptic children, mainly because some anticonvulsant drugs induce the enzymes responsible for its metabolism. The purpose of the present study was to address vitamin D status among children and adolescents treated with anticonvulsant drugs and control subjects who reside in southern Switzerland, a high solar radiation region.

Between January and May 2013, total serum 25-hydroxyvitamin D was assessed by liquid chromatography-tandem mass spectrometry in 58 children and adolescents with epilepsy and 29 controls residing in southern Switzerland. Dark-skinned individuals, females wearing dress styles covering practically the whole body and subjects with body mass index ≥85th percentile for age and sex were excluded.

Concentration of serum 25-hydroxyvitamin D was similar in epilepsy patients (48 [37-62] nmol/l; median and interquartile range) and controls (53 [47-64] nmol/l). An inadequate serum 25-hydroxyvitamin D concentration was common both among patients (55%) and control subjects (34%).

Serum 25-hydroxyvitamin D was significantly lower among patients treated with anticonvulsant drugs that induce the metabolism of vitamin D (30 [21-51] nmol/l) than among the remaining patients (51 [40-65] nmol/l) and controls.

The present study indicates a relevant tendency towards inadequate vitamin D status among children with and without anticonvulsant drug management who reside in southern Switzerland. This tendency is more prominent in patients treated with anticonvulsant drugs that induce the metabolism of 25-hydroxyvitamin D.

From PDF
carbamazepine, oxcarbazepine, phenobarbital, phenytoin

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Effect of carbamazepine therapy on vitamin D and parathormone in epileptic children - Nov 2010

Clinical Trial Pediatr Neurol . 2010 Nov;43(5):320-4. doi: 10.1016/j.pediatrneurol.2010.05.013.
Abhijit Misra 1, Anju Aggarwal, Om Singh, Sangeeta Sharma

Evidence suggests that carbamazepine affects bone metabolism by altering vitamin D status. We prospectively compared 25-hydroxyvitamin D, parathormone, calcium, phosphorus, and alkaline phosphatase levels at initiation and 6 months of carbamazepine therapy in children, and correlated them with carbamazepine levels. We included 47 children newly diagnosed with partial epilepsy, initiated on carbamazepine therapy. Of these, 32 were studied for 6 months. Children were managed according to standard protocol. Various parameters were measured at initiation and at 6 months. Carbamazepine levels were estimated after 6 months. Mean age was 6.72 ± 2.22 years S.D. Mean 25-hydroxyvitamin D was 14.45 ± 9.77 ng/mL S.D. and 11.31 ± 9.15 ng/mL S.D. at baseline and 6 months (P = 0.023), respectively (21.7% decline). Mean parathormone increased from 34.24 ± 21.38 pg/mL S.D. to 45.01 ± 24.46 pg/mL S.D. (P = 0.001). Change in vitamin D correlated negatively with change in parathormone (r = -0.404, P = 0.022). Serum alkaline phosphatase increased from 283.50 ± 100.10 IU/L S.D. to 364.25 ± 126.98 IU/L S.D. (P < 0.001). Changes in vitamin D and parathormone did not correlate significantly with carbamazepine level. Carbamazepine therapy decreased levels of vitamin D. Hence vitamin

VitaminDWiki - Interactions with Vitamin D has:

Interactions with Vitamin D has 109 items

Various drugs decrease Vitamin D
Drugs that may harm bone (vitamin D needed) -April 2016
Statins and Vitamin D - many studies
Glyphosate decreases Vitamin D getting to cells in many ways
24 drugs that typically reduce Vitamin D levels – Review Aug 2021
Drugs which create a vitamin D deficiency
Antibiotics and Vitamin D are associated with many of the same diseases
A few Drugs increase Vitamin D
Contraceptives,   Probiotics
Vitamin D can decrease/increase impact of drugs
be careful of Chemotheraphy and Vitamin D
Vitamin D generally improves the efficacy of drugs while reducing their adverse effects – Jan 2020
Some Drugs decrease Vitiamin D co-factors or limit vitamin D getting to cells
Drugs which create deficiencies in Vitamin D, Vitamin K, Magnesium, Zinc, Iron, etc. – Sept 2017
Drugs Deplete Magnesium
Interaction of drugs with Vitamin D cofactors
Non-drugs also decrease vitamin D levels in blood and cells
Air pollution, toxins, heavy metals and smoking each result in lower Vitamin D levels – Nov 2018
Air Pollution reduces Vitamin D
Pesticides increase risk of Cancers, Alz, ALS, Asthma, ADHD, etc. (all related to low vitamin D) – Oct 2016
Plastics, BPA, PCB and Vitamin D deficiency
Smoking   Coffee
Cooked dried beans or peas

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