Besag Frank M C, Berry David
Bedfordshire and Luton Partnership NHS Trust, Luton University and Institute of Epileptology, London, UK.
Drug Saf. 2006;29(2):95-118. doi: 10.2165/00002018-200629020-00001.
Antiepileptic and antipsychotic drugs are often prescribed together. Interactions between the drugs may affect both efficacy and toxicity. This is a review of human clinical data on the interactions between the antiepileptic drugs carbamazepine, valproic acid (sodium valproate), vigabatrin, lamotrigine, gabapentin, topiramate, tiagabine, oxcarbazepine, levetiracetam, pregabalin, felbamate, zonisamide, phenobarbital and phenytoin with the antipsychotic drugs risperidone, olanzapine, quetiapine, clozapine, amisulpride, sulpiride, ziprasidone, aripiprazole, haloperidol and chlorpromazine; the limited information on interactions between antiepileptic drugs and zuclopenthixol, periciazine, fluphenazine, flupenthixol and pimozide is also presented. Many of the interactions depend on the induction or inhibition of the cytochrome P450 isoenzymes, but other important mechanisms involve the uridine diphosphate glucuronosyltransferase isoenzymes and protein binding. There is some evidence for the following effects. Carbamazepine decreases the plasma concentrations of both risperidone and its active metabolite. It also decreases concentrations of olanzapine, clozapine, ziprasidone, haloperidol, zuclopenthixol, flupenthixol and probably chlorpromazine and fluphenazine. Quetiapine increases the ratio of carbamazepine epoxide to carbamazepine and this may lead to toxicity. The data on valproic acid are conflicting; it may either increase or decrease clozapine concentrations, and it appears to decrease aripiprazole concentrations. Chlorpromazine possibly increases valproic acid concentrations. Lamotrigine possibly increases clozapine concentrations. Phenobarbital decreases clozapine, haloperidol and chlorpromazine concentrations. Phenytoin decreases quetiapine, clozapine, haloperidol and possibly chlorpromazine concentrations. There are major gaps in the data. In many cases there are no published clinical data on interactions that would be predicted on theoretical grounds.
抗癫痫药物和抗精神病药物常常联合使用。药物之间的相互作用可能会影响疗效和毒性。本文综述了关于抗癫痫药物卡马西平、丙戊酸（丙戊酸钠）、氨己烯酸、拉莫三嗪、加巴喷丁、托吡酯、替加宾、奥卡西平、左乙拉西坦、普瑞巴林、非氨酯、唑尼沙胺、苯巴比妥和苯妥英与抗精神病药物利培酮、奥氮平、喹硫平、氯氮平、氨磺必利、舒必利、齐拉西酮、阿立哌唑、氟哌啶醇和氯丙嗪之间相互作用的人体临床数据；同时也列出了关于抗癫痫药物与珠氯噻醇、奋乃静、氟奋乃静、三氟噻吨和匹莫齐特之间相互作用的有限信息。许多相互作用取决于细胞色素P450同工酶的诱导或抑制，但其他重要机制涉及尿苷二磷酸葡萄糖醛酸转移酶同工酶和蛋白结合。有证据表明存在以下效应。卡马西平会降低利培酮及其活性代谢物的血浆浓度。它还会降低奥氮平、氯氮平、齐拉西酮、氟哌啶醇、珠氯噻醇、三氟噻吨的浓度，可能还会降低氯丙嗪和氟奋乃静的浓度。喹硫平会增加卡马西平环氧化物与卡马西平的比例，这可能导致毒性。关于丙戊酸的数据存在矛盾；它可能会增加或降低氯氮平的浓度，并且似乎会降低阿立哌唑的浓度。氯丙嗪可能会增加丙戊酸的浓度。拉莫三嗪可能会增加氯氮平的浓度。苯巴比妥会降低氯氮平、氟哌啶醇和氯丙嗪的浓度。苯妥英会降低喹硫平、氯氮平、氟哌啶醇的浓度，可能还会降低氯丙嗪的浓度。数据存在重大空白。在许多情况下，没有关于基于理论预测的相互作用的已发表临床数据。
