新型抗癫痫药物的严重不良反应及其防范  

Serious Adverse Drug Reactions of New Antiepileptic Drugs and Its Prevention

作　　者：徐德[1] 郑荣远[1] 

机构地区：[1]温州医学院附属第一医院神经内科,浙江温州325000

出　　处：《药物流行病学杂志》2010年第2期74-78,共5页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:综合5种新型抗癫痫药物在国外文献中报道的严重不良反应(Serious adverse reactions,SARs),提出相应的防范措施。方法:检索1990～2009年MEDLINE/PUBMED数据库中有关新型抗癫痫药物不良反应的文献,从中筛选出5种新型抗癫痫药物SARs的英文文献共132篇,将其SARs的临床表现、发生率、机制、危险因素、预防措施进行总结和分析。结果:加巴喷丁(GBP)可引起行为异常、认知障碍、诱发肌阵挛发作;拉莫三嗪(LTG)可引起严重皮疹、肝肾功能衰竭、弥散血管内凝血、致畸;左乙拉西坦(LEV)可引起抑郁、行为异常、自杀倾向;托吡酯(TPM)可引起抑郁、认知障碍、急性闭角性青光眼、肾结石;奥卡西平(OXC)可引起低钠血症、血管神经性水肿、加重肌阵挛发作等。若能个体化选用抗癫痫新药,并采取合理的预防措施,可以避免或降低用药风险。结论:已在我国上市的新型抗癫痫药物均有SARs,这些不良反应导致了患者的生活质量下降,甚至危及生命,因此,临床医师在选用药物、监护治疗时必须熟悉与警惕这些新药的SARs,制定防范措施。Objective ： To summarize some serious adverse reactions of new antiepileptic drugs in post - marketing surveillence in China and to provide some suggestions for its risk management and rational use in clinic. Methods： 132 English literatures were selected from Medline / Pubmed database in 1990 - 2009. Then, their serious adverse reactions, such as clinical manifestations, incidence, mechanisms, risk factors and preventive measures were summed up Results： Gabapentin might cause abnormal behaviors, cognitive dysfunctions and myoclonic seizures induction; lamotrigine could cause serious skin rashes, liver and kidney failure, diffuse intravascular coagulation and teratogenesis ; levetiraeetam could cause depression, abnormal behavior and suicidal tendencies; topiramate could cause depression, cognitive impairment, acute angle closure glaucoma, and kidney stones; and oxcarbazepine could cause hyponatremia, angioneurotic edema, and myoclonie seizures increase. Both individual administration and reasonable precautions could avoid or reduce the risk in the use of new antiepileptic drugs. Conclusions： A variety of new antiepileptic drugs had their serious side effects, which led to the decline of life quality, and even endangered patients＇ lives. So doctors should pay attention to those serious side effects and the safe monitoring and rational use of new antiepileptic drugs should be strengthened.

关 键 词：新型抗癫痫药 严重不良反应 加巴啧丁 拉莫三嗪 托吡酯 左乙拉西坦 奥卡西平 

分 类 号：R971.6[医药卫生—药品]