Na úrovni farmakokinetiky jsou lékové interakce antiepileptik spojeny obvykle s enzymatickou indukcí nebo inhibicí. Méně časté jsou interakce v oblasti absorpce, vazby na plazmatické bílkoviny nebo renální exkrece. Farmakodynamické interakce antiepileptik s dalšími látkami se zřídka týkají synergismu s možností snížení dávek, spíše se zvyšuje incidence vedlejších účinků. Čistě farmakodynamické interakce byly popsány u oxcarbazepinu, perampanelu a pregabalinu.

Drug interactions of antiepileptic drugs are mostly connected with enzymatic induction or inhibition. The interaction on level of absorption, plasma-protein binding of renal excretion is less frequent. Pharmacodynamic interaction of antiepileptics with other drugs is seldom synergistic with a possibility of declination of dose. The increase of adverse drug reactions is more common. Purely pharmacodynamic interaction was described with oxcarbazepin, perampanel and pregabalin. The new antiepileptics have lower interaction potential - most of them are excreted either via kidney or extrahepatal (e. g. gabapentin, lacosamide, levetiracetam, topiramate, vigabatrin). Enzymatic induction is either not present or minimal. The inductive effect is necessary to be taken into account in carbamazepine, phenytoin and phenobarbital. Inhibitive effect is held in valproic acid and felbamate. The interactive potential among newer antiepileptics is the highest in lamotrigine, oxcarbazepine and rufinamide. Drug interactions were not found in lacosamide, pregabalin, stiripentol and vigabatrin.

Oddělení klinické farmakologie Ústav laboratorní medicíny Fakultní nemocnice Ostrava

Ústav klinické farmakologie Lékařská fakulta Ostravská Univerzita Ostrava

Drug interactions of antiepileptic drugs. Part 2, interaction with drugs of other indication groups

interakce s léky z jiných indikačních skupin

interaction with drugs of other indication groups