目的：探討國內某護理之家住民使用抗癲癇藥物的現況及評估用藥的適當性。
方法：採回溯性病歷分析法，期間為2009 年4 月至2010 年3 月，針對某地區醫院附設護理之家住民，紀錄抗癲癇藥物使用情形。
結果：21%的住民使用抗癲癇藥物，約兩倍於國外文獻(10.5-11%)。使用抗癲癇藥物的住民，平均用藥品項數8.0±2.8 高於未使用者7.2±2.9。單一抗癲癇藥物使用者有63 例 (77.8%)。最常使用的抗癲癇藥物為 phenytoin、valproate 及新一代的抗癲癇藥物levetiracetam、topiramate、oxcarbazepine。除了levetiracetam 外，抗癲癇藥物的每日處方劑量 (prescribed daily dose, PDD) 均低於定義每日劑量 (defined daily dose, DDD)。52.5%的住民有監測抗癲癇藥物血中濃度，濃度過高者則立即停藥。這段期間有3 位住民因癲癇發作而緊急就醫。未有藥物濃度過高相關的副作用產生。有1 位住民發生phenytoin 引起的皮膚過敏不良反應，停藥後症狀獲得緩解。
結論：抗癲癇用藥的高使用率主要可能由於疾病嚴重度、失能程度及民情不同的因素。藥師應多方面執行以住民為中心的長期藥事照護，確保護理之家住民抗癲癇用藥的臨床成效及用藥安全。
 

Purpose: The purposes of this study were to describe the prescriptions and assess the appropriateness of antiepileptic drug (AEDs) therapy in district nursing home residents.
Method: We retrospectively reviewed the medical records of residents during April 2009 to March 2010 in a district hospital nursing home.
Result: Of 383 nursing home residents, 81 (21%) received AEDs therapy. The prevalence of AEDs use was almost twice as compared to the previous foreign study. The average number of medications taken by AEDs users was 8.0 ± 2.8, greater than the average of 7.2 ± 2.9 for other residents. The most frequently five prescribed AEDs were phenytoin, valproate, topiramate, levetiracetam and oxcarbazepine.The AEDs prescribed daily doses (PDD) were lower than defined daily doses (DDD), except levetiracetam. We monitored AEDs levels in 32 residents (52.5%) and discontinued AEDs if serum concentrations were above the normal ranges. There was no high AEDs concentration related side effects. During study period, 3 residents (3.7%) received emergency medical intervention because of seizures attacked. A resident developed skin rashes while taking phenytoin. Symptom relieved after stopping phenytoin.
Conclusion: The high rate of AEDs utilization may be due to high degree of disease severity, disability and different customs. Pharmacists should provide the resident-centered long-term pharmaceutical care and to ensure the clinical effectiveness and safety of AEDs use in nursing home residents.