Liedtke Michelle D, Lockhart Staci M, Rathbun R Chris
Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.
Ann Pharmacother. 2004 Mar;38(3):482-9. doi: 10.1345/aph.1D309. Epub 2004 Jan 23.
To evaluate the clinical significance of interactions between anticonvulsant and antiretroviral agents and provide recommendations regarding their concurrent use.
A PubMed search (1966 to April 2003) was conducted using individual anticonvulsant and antiretroviral drug names and the following key search terms: anticonvulsant, antiepileptic, antiretroviral, protease inhibitor, and pharmacokinetic. Abstracts from scientific meetings that pertained to drug interactions were manually reviewed.
All articles identified by the PubMed search were examined. Articles and abstracts from scientific meetings with relevant information were included.
Six case reports were identified that describe interactions between anticonvulsant agents and protease inhibitors. In several reports, carbamazepine serum concentrations increased by approximately two- to threefold with concurrent ritonavir, resulting in carbamazepine-related toxicity. Carbamazepine was also associated with loss of viral suppression when combined with indinavir. Phenytoin serum concentrations were decreased with nelfinavir in a patient who developed recurrent seizures. The effect of ritonavir on phenytoin was variable; a 30% reduction in phenytoin serum concentration occurred in one patient, while no apparent change was observed in another. Interactions with nonnucleoside reverse-transcriptase inhibitors are poorly characterized because existing data involve concurrent protease inhibitor therapy. The utility of newer anticonvulsant agents is explored. Experience with newer anticonvulsant agents in 2 patients at our site is also described.
Limited data exist regarding interactions between anticonvulsant and antiretroviral agents. Valproic acid and newer anticonvulsant agents may provide useful alternatives to first-generation agents. Clinicians need to be diligent when monitoring for anticonvulsant-antiretroviral interactions because of the potential for toxicity, loss of seizure control, and incomplete viral suppression.
评估抗惊厥药与抗逆转录病毒药物之间相互作用的临床意义，并就其联合使用提供建议。
利用单个抗惊厥药和抗逆转录病毒药物名称以及以下关键检索词在PubMed数据库（1966年至2003年4月）中进行检索：抗惊厥药、抗癫痫药、抗逆转录病毒药、蛋白酶抑制剂和药代动力学。人工查阅了与药物相互作用相关的科学会议摘要。
检查PubMed检索所识别的所有文章。纳入具有相关信息的科学会议文章和摘要。
识别出6例描述抗惊厥药与蛋白酶抑制剂之间相互作用的病例报告。在几份报告中，同时使用利托那韦时，卡马西平血清浓度升高约2至3倍，导致与卡马西平相关的毒性反应。卡马西平与茚地那韦合用时也与病毒抑制作用丧失有关。一名出现癫痫复发的患者，奈非那韦使苯妥英血清浓度降低。利托那韦对苯妥英的影响不一；一名患者苯妥英血清浓度降低了30%，而另一名患者未观察到明显变化。与非核苷类逆转录酶抑制剂的相互作用特征尚不明确，因为现有数据涉及同时进行蛋白酶抑制剂治疗的情况。探讨了新型抗惊厥药的效用。还描述了我们机构2例患者使用新型抗惊厥药的经验。
关于抗惊厥药与抗逆转录病毒药物之间的相互作用，现有数据有限。丙戊酸和新型抗惊厥药可能为第一代药物提供有用的替代选择。由于存在毒性、癫痫控制丧失和病毒抑制不完全的可能性，临床医生在监测抗惊厥药 - 抗逆转录病毒药物相互作用时需要格外小心。
