de Leon Jose
University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, Estados Unidos; Grupo de Investigación en Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada, Granada, España; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España.
Rev Psiquiatr Salud Ment. 2015 Apr-Jun;8(2):97-115. doi: 10.1016/j.rpsm.2014.10.006. Epub 2015 Mar 3.
The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. This is part i of a comprehensive review on antiepileptic drug (AED) inducers using both mechanistic pharmacological and evidence-based medicine to provide practical recommendations to neurologists and psychiatrists concerning how to control for them. Carbamazepine, phenobarbital and phenytoin, are clinically relevant AED inducers; correction factors were calculated for studied induced drugs. These correction factors are rough simplifications for orienting clinicians, since there is great variability in the population regarding inductive effects. As new information is published, the correction factors may need to be modified. Some of the correction factors are so high that the drugs (e.g., bupropion, quetiapine or lurasidone) should not co-prescribed with potent inducers. Clobazam, eslicarbazepine, felbamate, lamotrigine, oxcarbazepine, rufinamide, topiramate, vigabatrin and valproic acid are grouped as mild inducers which may (i)be inducers only in high doses; (ii)frequently combine with inhibitory properties; and (iii)take months to reach maximum effects or de-induction, definitively longer than the potent inducers. Potent inducers, definitively, and mild inducers, possibly, have relevant effects in the endogenous metabolism of (i)sexual hormones, (ii) vitamin D, (iii)thyroid hormones, (iv)lipid metabolism, and (v)folic acid.
癫痫和双相情感障碍中诱导剂的文献受到假阴性结果的严重影响。这是关于抗癫痫药物（AED）诱导剂的全面综述的第一部分，使用机械药理学和循证医学为神经科医生和精神科医生提供有关如何控制这些诱导剂的实用建议。卡马西平、苯巴比妥和苯妥英是临床上相关的AED诱导剂；已针对所研究的诱导药物计算了校正因子。这些校正因子只是为指导临床医生而进行的粗略简化，因为人群中诱导作用存在很大差异。随着新信息的发表，校正因子可能需要修改。有些校正因子非常高，以至于某些药物（如安非他酮、喹硫平或鲁拉西酮）不应与强效诱导剂联合使用。氯巴占、艾司利卡西平、非氨酯、拉莫三嗪、奥卡西平、卢非酰胺、托吡酯、氨己烯酸和丙戊酸被归类为轻度诱导剂，它们可能（i）仅在高剂量时为诱导剂；（ii）常兼具抑制特性；（iii）需要数月才能达到最大诱导效果或去诱导效果，肯定比强效诱导剂所需时间更长。强效诱导剂肯定会，而轻度诱导剂可能会对内源性（i）性激素、（ii）维生素D、（iii）甲状腺激素、（iv）脂质代谢和（v）叶酸的代谢产生相关影响。
