Stefanović Srđan, Janković Slobodan M, Novaković Milan, Milosavljević Marko, Folić Marko
a Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia.
Expert Opin Drug Metab Toxicol. 2018 Feb;14(2):153-159. doi: 10.1080/17425255.2018.1421172. Epub 2017 Dec 26.
Anticonvulsants that belong to the third generation are considered as 'newer' antiepileptic drugs, including: eslicarbazepine acetate, lacosamide, perampanel, brivaracetam, rufinamide and stiripentol. Areas covered: This article reviews pharmacodynamics (i.e. mechanisms of action) and clinically relevant drug-drug interactions of the third-generation antiepileptic drugs. Expert opinion: Newer antiepileptic drugs have mechanisms of action which are not shared with the first and the second generation anticonvulsants, like inhibition of neurotransmitters release, blocking receptors for excitatory amino acids and new ways of sodium channel inactivation. New mechanisms of action increase chances of controlling forms of epilepsy resistant to older anticonvulsants. Important advantage of the third-generation anticonvulsants could be their little propensity for interactions with both antiepileptic and other drugs observed until now, making prescribing much easier and safer. However, this may change with new studies specifically designed to discover drug-drug interactions. Although the third-generation antiepileptic drugs enlarged therapeutic palette against epilepsy, 20-30% of patients with epilepsy is still treatment-resistant and need new pharmacological approach. There is great need to explore all molecular targets that may directly or indirectly be involved in generation of seizures, so a number of candidate compounds for even newer anticonvulsants could be generated.
第三代抗惊厥药物被视为“新型”抗癫痫药物，包括：醋酸艾司利卡西平、拉科酰胺、吡仑帕奈、布瓦西坦、卢非酰胺和司替戊醇。涵盖领域：本文综述了第三代抗癫痫药物的药效学（即作用机制）和临床相关的药物相互作用。专家观点：新型抗癫痫药物具有第一代和第二代抗惊厥药物所没有的作用机制，如抑制神经递质释放、阻断兴奋性氨基酸受体以及钠通道失活的新方式。新的作用机制增加了控制对传统抗惊厥药物耐药的癫痫类型的机会。第三代抗惊厥药物的一个重要优势可能是，到目前为止观察到它们与抗癫痫药物及其他药物相互作用的倾向较小，这使得处方开具更加容易和安全。然而，随着专门设计用于发现药物相互作用的新研究的开展，这种情况可能会改变。尽管第三代抗癫痫药物扩大了对抗癫痫的治疗范围，但仍有20% - 30%的癫痫患者对治疗耐药，需要新的药理学方法。迫切需要探索所有可能直接或间接参与癫痫发作产生的分子靶点，以便能够开发出更多更新型抗惊厥药物的候选化合物。
