抗驚厥藥是治療癲癇病人的主要治療手段,，但該藥標注的用藥指針還包括了躁郁癥、狂躁癥,、神經(jīng)痛（沿著某一神經(jīng)走向的突發(fā)性的短暫銳痛）,、偏頭痛以及神經(jīng)病變性疼痛。
據(jù)4月14日刊JAMA上的一則研究披露,，一項對處方和臨床事例的數(shù)據(jù)分析表明,，使用某些抗驚厥藥物可能與患者自殺、企圖自殺或暴死風險的增加有關,。
文章的作者寫道：“這些抗驚厥藥物的廣泛的用藥指針以及它們在同時伴有或不伴有精神性并存疾病的患者中作為抗驚厥藥物的經(jīng)常性的使用都使它們的安全性成為一個具有極大關系的問題,。在2008年，美國食品及藥物管理局要求在抗驚厥藥物上貼上有關該藥物會增加自殺性思維以及行為的風險的警示性標簽,。這項決定是基于一則薈萃分析,，因為這些數(shù)據(jù)不夠多所以無法用于對個別藥物的調查,。”
Brigham and Wom-en's Hospital 和 Harvard Medical School, Boston的Elisabetta Patorno, M.D., M.P.H.及其同僚對這些藥物是否會增加患者的自殺企圖或成功自殺的風險進行了評估,，并將與一系列的抗驚厥藥物有關的自殺性行為或暴死與在患者亞分組內的自殺性的行為或暴死結合在了一起。 研究人員對來自HealthCore Integrated Research Database (包括那些領取處方藥及臨床所遇病例的資訊)的年齡在15歲或以上的患者的數(shù)據(jù)進行了分析,，這些患者是在2001年至2006年12月間服用某種抗驚厥藥物的,。
這項研究發(fā)現(xiàn)了827起自殺性行為（801起自殺企圖以及26起完成的自殺）以及另外在29萬7620起新的服用某種抗驚厥藥物治療中所發(fā)生的41起暴死（868起結合的自殺行為或暴死）事件。 研究人員發(fā)現(xiàn),，與topiramate相比,，gabapentin、 lamotrigine,、 oxcarbazepine,、 tiagabine、及 valproate的發(fā)生自殺行為的風險會有所增加,。 “納入了暴死事件的分析也產生了類似的結果,。在與carbamazepine 進行比較時，Gabapentin服用者在年輕和老年患者、心境障礙患者,、癲癇患者等亞組中的自殺風險會有所增加,。”
“這一探索性的分析可增進人們對抗驚厥藥物的使用與自殺風險之間的復雜而且鮮為人知的關系的了解,。”(生物谷Bioon.com)
生物谷推薦原文出處：
JAMA. 2010;303(14):1401-1409.
Anticonvulsant Medications and the Risk of Suicide, Attempted Suicide, or Violent Death
Elisabetta Patorno, MD, MPH; Rhonda L. Bohn, MPH, ScD; Peter M. Wahl, MLA, MS; Jerry Avorn, MD; Amanda R. Patrick, MS; Jun Liu, MD, MS; Sebastian Schneeweiss, MD, ScD
Context In 2008, the US Food and Drug Administration mandated warning labeling for anticonvulsant medications regarding the increased risk of suicidal thoughts and behaviors. The decision was based on a meta-analysis not sufficiently large to investigate individual drugs.
Objective To evaluate the risk of suicidal acts and combined suicidal acts or violent death associated with individual anticonvulsants.
Design A cohort study of the risk of suicidal acts and combined suicidal acts or violent death in patients beginning use of anticonvulsant medications compared with patients initiating a reference anticonvulsant drug.
Setting and Patients Patients 15 years and older from the HealthCore Integrated Research Database (HIRD) who began taking an anticonvulsant between July 2001 and December 2006.
Main Outcome Measures Cox proportional hazards models and propensity score–matched analyses were used to evaluate risk of attempted or completed suicide and combined suicidal acts or violent death, controlling for psychiatric comorbidities and other risk factors, among individual anticonvulsants compared with topiramate and secondarily carbamazepine.
Results The study identified 26 completed suicides, 801 attempted suicides, and 41 violent deaths in 297 620 new episodes of treatment with an anticonvulsant (overall median follow-up, 60 days). The incidence of the composite outcomes of completed suicides, attempted suicides, and violent deaths for anticonvulsants used in at least 100 treatment episodes ranged from 6.2 per 1000 person-years for primidone to 34.3 per 1000 person-years for oxcarbazepine. The risk of suicidal acts was increased for gabapentin (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.11-1.80), lamotrigine (HR, 1.84; 95% CI, 1.43-2.37), oxcarbazepine (HR, 2.07; 95% CI, 1.52-2.80), tiagabine (HR, 2.41; 95% CI, 1.65-3.52), and valproate (HR, 1.65; 95% CI, 1.25-2.19), compared with topiramate. The analyses including violent death produced similar results. Gabapentin users had increased risk in subgroups of younger and older patients, patients with mood disorders, and patients with epilepsy or seizure when compared with carbamazepine.
Conclusion This exploratory analysis suggests that the use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine, compared with the use of topiramate, may be associated with an increased risk of suicidal acts or violent deaths.
