Armijo J A, Herranz J L
Farmacología Clínica, Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, 39008 Santander, España.
Rev Neurol. 2007;45(4):236-44.
As the foundation underlying rational combination therapy it is necessary to consider the mechanism of action of each antiepileptic drug, its spectrum, the safety and pharmacodynamic and pharmacokinetic interactions, and to select the association of antiepileptic drugs in accordance with these factors.
This paper consists of three parts. In this third part we consider possible associations between antiepileptic drugs; we suggest associations that may be beneficial, others that must be kept under surveillance because their advantages can be offset by their drawbacks, and others that should be avoided because their disadvantages outweigh their possible advantages.
Until more is known about the aetiopathogenesis of epilepsy and we have markers of the cause of epilepsy in a particular patient it will not be possible to associate antiepileptic drugs according to their mechanisms of action. The absence of clinical trials only allows us to make suggestions about possible beneficial or harmful associations depending on the pharmacodynamic and pharmacokinetic characteristics of antiepileptic drugs, which can thus enhance their effectiveness and safety.
作为合理联合治疗的基础，有必要考虑每种抗癫痫药物的作用机制、其谱、安全性以及药效学和药代动力学相互作用，并根据这些因素选择抗癫痫药物的联合使用。
本文由三部分组成。在这第三部分中，我们考虑抗癫痫药物之间可能的联合使用；我们提出可能有益的联合使用，其他一些因其优点可能被缺点抵消而必须加以监测的联合使用，以及其他一些因其缺点超过可能的优点而应避免的联合使用。
在对癫痫的病因发病机制有更多了解并且我们有特定患者癫痫病因的标志物之前，根据抗癫痫药物的作用机制联合使用它们是不可能的。缺乏临床试验仅使我们能够根据抗癫痫药物的药效学和药代动力学特征对可能有益或有害的联合使用提出建议，从而提高其有效性和安全性。
