臨床常用抗癲癇藥物根據(jù)其藥動(dòng)學(xué)特點(diǎn)可分為主要經(jīng)肝代謝、主要經(jīng)腎排泄和肝腎雙通道清除。肝功能不全患者盡量選擇主要經(jīng)腎排泄的抗癲癇藥物，如加巴噴丁、普瑞巴林，或評(píng)估肝功能不全的程度，適當(dāng)?shù)臏p少劑量。腎功能不全的患者盡量選擇主要經(jīng)肝代謝的抗癲癇藥物，如丙戊酸鈉、卡馬西平、拉莫三嗪，或評(píng)估患者的肌酐清除率（CLcr），根據(jù)CLcr進(jìn)行劑量調(diào)整。對(duì)于透析的患者，結(jié)合血藥濃度監(jiān)測(cè)透析后補(bǔ)充劑量有助于個(gè)體化治療。肝腎功能不全患者抗癲癇藥物的選擇、劑量調(diào)整應(yīng)綜合考慮患者肝腎功能情況、藥物代謝特點(diǎn)、合并疾病、個(gè)體耐受性等因素，在抗癲癇藥物使用過程中，加強(qiáng)對(duì)藥物相互作用、藥物不良反應(yīng)等的監(jiān)護(hù)，結(jié)合血藥濃度監(jiān)測(cè)，以提高臨床用藥的有效性與安全性。

According to the pharmacokinetic characteristics, commonly used antiepileptic drugs (AEDs) can be divided into major hepatic metabolism, major renal excretion, and a combination of hepatic metabolism and renal excretion. For patients with hepatic dysfunction, try to choose AEDs that are mainly excreted by renal, such as gabapentin or pregabalin, or evaluate the degree of hepatic dysfunction, and reduce the dose appropriately. For patients with renal dysfunction, choose AEDs that are mainly metabolized by liver, such as sodium valproate, carbamazepine or lamotrigine, or evaluate the patient's creatinine clearance rate (CLcr) and adjust the dose according to the CLcr. For dialysis patients, supplementing the dose after dialysis combined with therapeutic drug monitoring (TDM) is helpful for individualized treatment. The selection and dose adjustment of AEDs in patients with hepatic/renal dysfunction should take into account the degree of patient's hepatic/renal dysfunction, drug metabolism characteristics, combined diseases, individual tolerance and other factors. During the use of AEDs, the monitoring of drug interactions and adverse drug reactions should be strengthened and combined with TDM to improve the effectiveness and safety of clinical application.

R971