Israni Rubeen K, Kasbekar Nishaminy, Haynes Kevin, Berns Jeffrey S
Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Semin Dial. 2006 Sep-Oct;19(5):408-16. doi: 10.1111/j.1525-139X.2006.00195.x.
The number of medications used to treat different types of seizures has increased over the last 10-15 years. Most of the newer antiepileptic drugs (AEDs) are likely to be unfamiliar to many nephrologists. For both the older and newer AEDs, basic pharmacokinetic information, recommendations for drug dosing in patients with reduced kidney function or who are on dialysis, and adverse renal and fluid-electrolyte effects are reviewed. Newer AEDs are less likely to have significant drug-drug interactions than older agents, but are more likely to need dosage adjustment in patients with reduced kidney function. The most common renal toxicities of these drugs include metabolic acidosis, hyponatremia, and nephrolithiasis; interstitial nephritis and other adverse effects are less common. Little is known about the clearance of most of the newer AEDs with high-efficiency hemodialyzers or with peritoneal dialysis. Monitoring of drug levels when available, careful clinical assessment of patients taking AEDs, and close collaboration with neurologists is essential to the management of patients taking AEDs.
在过去10至15年里，用于治疗不同类型癫痫发作的药物数量有所增加。许多肾脏病学家可能对大多数新型抗癫痫药物（AEDs）并不熟悉。本文综述了新旧AEDs的基本药代动力学信息、肾功能减退或接受透析患者的药物剂量推荐，以及肾脏和水电解质方面的不良反应。与旧药相比，新药发生显著药物相互作用的可能性较小，但肾功能减退患者更可能需要调整剂量。这些药物最常见的肾脏毒性包括代谢性酸中毒、低钠血症和肾结石；间质性肾炎和其他不良反应则较少见。对于大多数新型AEDs在高效血液透析器或腹膜透析中的清除情况，人们了解甚少。在可行时监测药物水平、对服用AEDs的患者进行仔细的临床评估，以及与神经科医生密切合作，对于管理服用AEDs的患者至关重要。
