Abstract
BACKGROUND: The present study was performed to investigate which antiepileptic drug (AED) has the highest risk of drug-induced parkinsonism (DIP). OBJECTIVE: The aim was to evaluate associations between AEDs and DIP reports in the World Health Organization pharmacovigilance database, Vigibase. METHODS: Individual case safety reports (ICSRs) in patients ≥45 years registered between January 1, 2000 and June 31, 2024 with carbamazepine, lamotrigine, levetiracetam, or sodium valproate as "Parkinson-like events" (PLE) were extracted. Disproportionality analyses were performed, with cases being PLE and non-cases all other ICSRs. Results are shown as reporting odds ratios (ROR). RESULTS: Among 16,174,796 ICSRs, 3339 reported PLE with the four AEDs, mainly in females between 45 and 64 years. The highest ROR value was with valproate sodium (3.09 [2.01-3.29]), followed by lamotrigine (2.14 [2.01-2.28]), levetiracetam (1.43 [1.32-1.55]), and carbamazepine (1.09 [1.01-1.17]). DIP risk increased with the number of associated AEDs. CONCLUSIONS: Among AEDs, valproate sodium is associated with the higher risk of PLE and carbamazepine with the lowest.