某醫學中心兒童住院病患抗癲癇藥物使用合理性之回溯性評估

The Retrospective Evaluation of Antiepileptic Drugs Utilization in Pediatric In-Patients of a Medical Center

洪碧蓮(Pi-Lien Hung) ； 林佩津(Pei-Chin Lin) ； 曾碧萊(Pi-Lai Tseng)

《臺灣臨床藥學雜誌》 22卷4期 (2014/12) Pp. 207-217

https://doi.org/10.6168/FJCP.2014.2204.02

摘要

目的：探討某醫學中心兒童住院病患使用抗癲癇藥物現況及評估藥品選用的適當性。方法：採回溯性病歷分析法，收案期間為2011年1月至12月，針對某醫學中心之兒童癲癇住院期間使用抗癲癇藥物個案，紀錄抗癲癇藥物使用情形。結果：因癲癇發作導致住院之病童，住院前不曾使用藥物者占54.5%，單一抗癲癇藥物使用占18.2%；其中最常被開立的藥物phenobarbital、clonazepam。入院後治療癲癇發作，處理誘發癲癇因素而未更動處方者占15.2%，增加藥物治療占72.7%；最常加入的藥物分別是valproate及phenobarbital，增加藥物劑量占12.1%；處方藥物為非許可使用範疇有oxcarbazepine、levetiracetam。研究期間，共有三例於收案期間產生藥物不良反應，另有兩例之用藥可能會發生交互作用。結論：兒童癲癇用藥合理性及安全性的評估：oxcarbazepine的使用，雖然相較於傳統藥物有相同的療效且副作用較phenytoin明顯減少，但以目前少量的研究結果，仍不適用於單一使用。基於未明確的療效及安全性考量，levetiracetam仍不建議用於未核准的年齡層。

關鍵字

兒童癲癇 ； 抗癲癇藥物 ； 藥物使用評估

並列摘要

Purpose: The purposes of this study were to describe the prescriptions and assess the appropriateness of antiepileptic drug (AEDs) selection in pediatric in-patients in a medical center. Method: We retrospectively reviewed the medical records of residents during January 2011 to December 2011 in the department of pediatrics. Result: For children with seizures resulted in hospitalization, they treated without antiepileptic drugs (AEDs) before hospitalization accounted for 54.5% and a single AED accounted for 18.2%; the most frequently prescribed drug were phenobarbital, clonazepam. After hospital admission for seizures control, the Dr. treated patients with epilepsy induced by prescription factors accounted for 15.2%, increased medicine treatment accounted for 72.7%; the most common drugs added were valproate and phenobarbital, increased dose accounted for 12.1%; prescription drugs of off-labeled used included oxcarbazepine and levetiracetam. During study period, three cases happened adverse drug reactions and two cases was observed obvious drug interactions. Conclusion: The evaluations of antiepileptic drugs utilization in pediatrics show that oxcarbazepine has the same efficacy with traditional medicines and is significantly reduced adverse effects compared with phenytoin. According to a small amount of the clinical research, oxcarbazepine is still not suitable for monotherapy. Not explicitly based on efficacy and safety considerations, levetiracetam is still not recommended for unapproved ages.

並列關鍵字

Pediatric Seizure ； Antiepileptic Drug ； Drug Utilization Evaluation