Antiseizure drugs and risk of developing smoking-related chronic obstructive pulmonary disease or lung cancer: A population-based case-control study

Br J Clin Pharmacol. 2021 Mar;87(3):1253-1263. doi: 10.1111/bcp.14501. Epub 2020 Aug 30.


Aims: To determine whether enzyme-inducing antiseizure drugs (ASDs) affect the risk of developing chronic obstructive pulmonary disease (COPD) or lung cancer in smokers.

Methods: Cases of COPD and lung cancer and matched controls without these conditions were identified from a population of smokers with ≥1 prescription for any type of ASD in the Clinical Practice Research Datalink UK database of patients managed in primary care (1995-2016). A matched case-control study was performed utilising multivariate logistic regression analyses of exposure to enzyme-inducing ASDs compared to non-enzyme-inducing ASDs. The duration of ASD exposure and level of tobacco exposure were also assessed.

Results: We identified 5952 incident COPD and 1373 incident lung cancer cases, and 59 328 and 13 681 matched controls, respectively. Compared with never use, ever use of enzyme-inducing ASDs was associated with slightly decreased risk estimates of COPD (adjusted odds ratio: 0.85, 95% confidence interval: 0.81-0.89) and lung cancer (adjusted odds ratio: 0.82, 95% confidence interval: 0.73-0.92). These risk estimates were attenuated in heavy smokers.

Conclusion: We found slightly decreased risk estimates of COPD and lung cancer among smokers taking enzyme-inducing ASDs and hypothesise that this may be related to induction of detoxification of tobacco-specific lung toxins.

Keywords: antiepileptic drugs; antiseizure drugs; bipolar disorder; chronic obstructive pulmonary disease; enzyme inducers; enzyme induction; epilepsy; lung cancer; neuropathic pain and migraine prophylaxis; smoking.

MeSH terms

  • Case-Control Studies
  • Humans
  • Lung Neoplasms* / chemically induced
  • Lung Neoplasms* / epidemiology
  • Pharmaceutical Preparations*
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • Risk Factors
  • Smoking / adverse effects


  • Pharmaceutical Preparations