Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Via Consolare Valeria, 98125 MESSINA, Italy.
Br J Clin Pharmacol. 2010 Oct;70(4):514-22. doi: 10.1111/j.1365-2125.2010.03619.x.
The aims of the study were to assess the trend of older and newer anti-epileptic drugs (AEDs) in the elderly population and to analyze the effects of a health-policy intervention with regard to AED use in general practice in a setting in Southern Italy.
Data were extracted from the 'Caserta-1' Local-Health-Unit Arianna database in the years 2004-07. Patients aged over 65 years, receiving at least one AED prescription and registered in the lists of 88 general practitioners, were selected. The use of older and newer AEDs was calculated as 1 year prevalence and incidence of use and defined daily dose (DDD) per 1000 inhabitants day(-1) . Sub-analyses by gender, age and indication of use were performed.
Most of AED users were treated because of neuropathic pain (64.8%). However, the main indication of use for older AEDs (57.8%) was epilepsy, whereas newer AEDs (79.5%) were used for neuropathic pain. Prevalence and incidence of newer AED use increased until 2006, followed by a reduction in 2007. Newer AEDs, particularly gabapentin and pregabalin, were used in the treatment of more patients than older AEDs. However phenobarbital, accounting for more than 50% of total AED volume, was the most prescribed medication during the entire study period.
An increasing use of AEDs has been observed during 2004-07, mostly due to the prescription of newer compounds for neuropathic pain. The fall in the use of newer AEDs during 2007 coincides with revised re-imbursement criteria for gabapentin and pregabalin. The large use of phenobarbital in the elderly should be considered in the light of a risk of adverse drug reactions.
本研究旨在评估在意大利南部某地区老年人群中，新型和传统抗癫痫药物（AED）的使用趋势，并分析一般实践中 AED 使用的卫生政策干预效果。
本研究数据来自 2004-07 年“卡塞塔-1”地方卫生单位阿里亚纳数据库。选择年龄在 65 岁以上、至少服用一种 AED 处方且登记在 88 名全科医生名单中的患者。使用新型和传统 AED 的 1 年患病率和发病率以及每 1000 居民天定义日剂量（DDD）来计算。进行了性别、年龄和使用适应证的亚分析。
大多数 AED 使用者因神经性疼痛（64.8%）接受治疗。然而，传统 AED 的主要适应证是癫痫（57.8%），而新型 AED 主要用于治疗神经性疼痛（79.5%）。新型 AED 的使用患病率和发病率在 2006 年之前增加，之后在 2007 年减少。新型 AED，特别是加巴喷丁和普瑞巴林，用于治疗的患者多于传统 AED。然而，苯巴比妥占 AED 总量的 50%以上，是整个研究期间处方最多的药物。
在 2004-07 年期间，AED 的使用有所增加，主要是由于新型化合物用于治疗神经性疼痛。2007 年新型 AED 使用减少与加巴喷丁和普瑞巴林重新补偿标准的修订相吻合。在老年人中大量使用苯巴比妥时，应考虑药物不良反应的风险。
