University of Kragujevac, Medical Faculty, Kragujevac, Serbia.
Expert Opin Drug Metab Toxicol. 2012 Jan;8(1):81-91. doi: 10.1517/17425255.2012.645535. Epub 2011 Dec 19.
Antiepileptic drugs are prescribed to patients of all ages and are commonly prescribed to patients over the age of 65. When prescribing these drugs to patients of this age bracket, treatment should be based not only on the diagnosis and seizure type but also on the propensity of the drugs for adverse effects and their drug-drug interactions.
This article reviews antiepileptic drugs currently used for treating the elderly and highlights the adverse effects and potential drug-drug interactions for these treatments. The article was complied through literature searches of the Cochrane database of systematic reviews, MEDLINE and SCindeks.
In elderly patients who have hepatic diseases, antiepileptic drugs that are not metabolized in the liver, such as levetiracetam, are preferred; in patients with moderate and severe renal failure, carbamazepine and valproic acid are the preferred antiepileptic drugs. Phenytoin, fosphenytoin, carbamazepine, oxcarbazepine and lamotrigine should not be prescribed in elderly patients with cardiac conduction abnormalities or a history of ventricular arrhythmia. While the majority of antiepileptic drugs interact with other drugs, hepatic enzymes and plasma proteins, a few newer antiepileptic drugs are free from such interactions (e.g., gabapentin, levetiracetam and tiagabine), which make them suitable candidates for elderly patients. However, in order to make further recommendations regarding the choice and dosing regimens of antiepileptic drugs in elderly patients, more extensive clinical research in this specific population is necessary.
抗癫痫药物被开给各个年龄段的患者，尤其常见于 65 岁以上的患者。在为这个年龄段的患者开具这些药物时，治疗方案不仅应基于诊断和发作类型，还应考虑药物的不良反应倾向及其药物相互作用。
本文综述了目前用于治疗老年人的抗癫痫药物，并强调了这些治疗方法的不良反应和潜在药物相互作用。本文通过对 Cochrane 系统评价数据库、MEDLINE 和 SCindeks 的文献检索进行了汇编。
在患有肝脏疾病的老年患者中，优选不经肝脏代谢的抗癫痫药物，如左乙拉西坦；在中度和重度肾功能衰竭的患者中，卡马西平、丙戊酸钠是优选的抗癫痫药物。对于存在心脏传导异常或室性心律失常病史的老年患者，不应开具苯妥英钠、苯妥英、卡马西平、奥卡西平、拉莫三嗪。虽然大多数抗癫痫药物与其他药物相互作用，影响肝酶和血浆蛋白，但少数新型抗癫痫药物不存在这种相互作用（如加巴喷丁、左乙拉西坦和噻加宾），使其成为老年患者的合适选择。然而，为了针对老年患者进一步提出抗癫痫药物的选择和剂量方案建议，还需要在这一特定人群中开展更广泛的临床研究。
