新型口服抗凝药与抗癫痫药的相互作用

Interactions between new oral anticoagulants and antiepileptic drugs

心房颤动是卒中最常见的原因。心房颤动卒中后的患者推荐口服抗凝药(OACs)进行二级预防,新型口服抗凝药(NOACs)因剂量固定、无需常规监测等优点在临床使用越来越广泛,有望替代华法林。卒中后可能会诱发癫痫,需要使用抗癫痫药(AEDs)进行治疗。NOACs均为P糖蛋白(P-gp)底物,且部分经细胞色素P450(CYP450)酶代谢;而已知某些抗癫痫药物(AEDs)可诱导P-gp或CYP450,从而影响NOACs的抗凝疗效。本文系统综述NOACs和AEDs之间药物相互作用,为临床合理使用NOACs提供参考。

Atrial fibrillation（ AF） is a frequent cause of stroke. Secondary prophylaxis by oral anticoagulants（OACs） is recommended after stroke in patients with AF. New oral anticoagulants（NOACs） are assumed to overcome some of the limitations of warfarin due to allowing fixed dosing without the need for laboratory monitoring, which is expected to replace warfarin. Stroke may induce epilepsy and most of these patients require long-term antiepileptic drugs（AEDs） treatment. All NOACs are the substrate of P-glycoprotein（P-gp）, and some are metabolized by cytochrome P450（CYP450） enzymes. Some of AEDs may induce P-gp or CYP450, which may affect the anticoagulant effect of NOACs. In this paper, drug-drug interactions between NOACs and AEDs were systematically reviewed, which provides reference for clinical rational use of NOACs.