抗癫痫药物在肝肾功能不全患者中使用的研究进展  

Research progress of use of antiepileptic drug in patients with hepatic and renal dysfunction

作　　者：章袁[1] 黄维惠[2] 高丽娜[2] ZHANG Yuan;HUANG WEI-hui;GAO LI-na(Department of Pharmacy,Tianjin First Central Hospital,Tianjin 300192,China;Department of Neurology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院药学部,天津300192 [2]天津市第一中心医院神经内科,天津300192

出　　处：《现代药物与临床》2020年第12期2488-2495,共8页Drugs & Clinic

摘　　要：临床常用抗癫痫药物根据其药动学特点可分为主要经肝代谢、主要经肾排泄和肝肾双通道清除。肝功能不全患者尽量选择主要经肾排泄的抗癫痫药物,如加巴喷丁、普瑞巴林,或评估肝功能不全的程度,适当的减少剂量。肾功能不全的患者尽量选择主要经肝代谢的抗癫痫药物,如丙戊酸钠、卡马西平、拉莫三嗪,或评估患者的肌酐清除率(CLcr),根据CLcr进行剂量调整。对于透析的患者,结合血药浓度监测透析后补充剂量有助于个体化治疗。肝肾功能不全患者抗癫痫药物的选择、剂量调整应综合考虑患者肝肾功能情况、药物代谢特点、合并疾病、个体耐受性等因素,在抗癫痫药物使用过程中,加强对药物相互作用、药物不良反应等的监护,结合血药浓度监测,以提高临床用药的有效性与安全性。According to the pharmacokinetic characteristics,commonly used antiepileptic drugs(AEDs)can be divided into major hepatic metabolism,major renal excretion,and a combination of hepatic metabolism and renal excretion.For patients with hepatic dysfunction,try to choose AEDs that are mainly excreted by renal,such as gabapentin or pregabalin,or evaluate the degree of hepatic dysfunction,and reduce the dose appropriately.For patients with renal dysfunction,choose AEDs that are mainly metabolized by liver,such as sodium valproate,carbamazepine or lamotrigine,or evaluate the patient's creatinine clearance rate(CLcr)and adjust the dose according to the CLcr.For dialysis patients,supplementing the dose after dialysis combined with therapeutic drug monitoring(TDM)is helpful for individualized treatment.The selection and dose adjustment of AEDs in patients with hepatic/renal dysfunction should take into account the degree of patient's hepatic/renal dysfunction,drug metabolism characteristics,combined diseases,individual tolerance and other factors.During the use of AEDs,the monitoring of drug interactions and adverse drug reactions should be strengthened and combined with TDM to improve the effectiveness and safety of clinical application.

关 键 词：抗癫痫药物 加巴喷丁 丙戊酸钠 肝肾功能不全 肌酐清除率 血药浓度监测 剂量调整 

分 类 号：R971[医药卫生—药品]