Lee Kelly C, Finley Patrick R, Alldredge Brian K
University of California, San Francisco, 521 Parnassus Avenue, C-152, Box 0622, San Francisco, CA 94143-0622, USA.
Expert Opin Drug Saf. 2003 May;2(3):233-47. doi: 10.1517/14740338.2.3.233.
Psychotropic medications in the classes of antidepressants, antipsychotics and mood stabilisers have been recognised in the literature and clinical settings as having high epileptogenic potential. Among these three classes, clozapine, tricyclic antidepressants (TCAs) and lithium are agents that clinicians have historically recognised as precipitants of drug-induced seizures. There are few reports that review the epileptogenic risk of newer psychotropic agents; in this qualitative review, the authors provide an update on the most recently published reports on seizures associated with antidepressants, antipsychotics, mood stabilisers, anxiolytics and sedative-hypnotics. In general, the epileptogenic risks of the newer psychotropic agents appear to be quite low as long as dosing strategies are consistent with recommended guidelines. Whilst newer psychotropic medications appear to be safe in patients with epilepsy, few studies have specifically addressed this population. In addition, the potential for drug interactions between antiepileptic drugs and psychotropics may be substantial with certain agents. For example, many psychotropes are both substrates and inhibitors of cytochrome P450 (CYP450) isoenzymes, whilst many antiepileptic drugs are both substrates and inducers of CYP450 activity. Every attempt should be made to minimise potential interactions when these agents are concomitantly administered.
抗抑郁药、抗精神病药和心境稳定剂这几类精神药物在文献和临床环境中已被公认为具有较高的致癫痫潜力。在这三类药物中，氯氮平、三环类抗抑郁药（TCAs）和锂盐是临床医生历来认为可引发药物性癫痫发作的药物。很少有报告综述新型精神药物的致癫痫风险；在这项定性综述中，作者提供了关于最近发表的与抗抑郁药、抗精神病药、心境稳定剂、抗焦虑药和镇静催眠药相关的癫痫发作报告的最新情况。一般来说，只要给药策略符合推荐指南，新型精神药物的致癫痫风险似乎相当低。虽然新型精神药物在癫痫患者中似乎是安全的，但很少有研究专门针对这一人群。此外，抗癫痫药物与精神药物之间的药物相互作用潜力在某些药物中可能很大。例如，许多精神药物既是细胞色素P450（CYP450）同工酶的底物又是抑制剂，而许多抗癫痫药物既是CYP450活性的底物又是诱导剂。当同时使用这些药物时，应尽一切努力尽量减少潜在的相互作用。
