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目的 探讨抗癫(癎)药物卡马西平、奥卡西平对华法林抗凝作用的影响和作用机制及处理方法.方法 1例78岁老年女性患者开始服用华法林后出现抵抗,根据患者用药情况判断为卡马西平导致的华法林抵抗,逐渐增加剂量后国际标准化比值(INR)稳定在治疗范围内;另1例女性患者长期服用稳定维持剂量的华法林抗凝治疗,因需联合使用奥卡西平向抗凝门诊咨询,根据药师建议按照原剂量服用并加强INR值监测,INR值未有波动.结果 卡马西平通过诱导华法林的代谢导致华法林代谢增加,所需剂量增加;奥卡西平的代谢不通过诱导型的的肝细胞酶,因此不会影响INR值的波动.结论 卡马西平可能会降低华法林的药效,奥卡西平作为抗癫痈药物在某些方面优于卡马西平,特别是与华法林联合用药时.“,”Objective To explore the interaction between warfarin and antiepileptic drugs such as carbamazepine and oxcarbazepine.Methods A 78-year-old woman suffered from warfarin resistance after initial warfarin dosing for several days.Based on her medication review,clinical pharmacist found that the warfarin resistance resulted from co-administered carbamazepine.Her warfarin dosage was increased,and the international normalized ratio (INR) increased to the target range.Another woman had been taking warfarin therapy for long time with a stable maintenance dose.She consulted clinical pharmacist for the influence of co-administered oxcarbazepine on warfarin.The patient was advised to maintain the dose and monitor her INR more closely.Her INR did not fluctuate.Results Carbamazepine induced warfarin metabolism.As a result,the patient needed increased dosage of warfarin to maintain the INR in the therapeutic target range.Oxcarbazepine does not induce liver enzymes,and therefore the INR did not fluctuate.Conclusion Carbamazepine may reduce the efficacy of warfarin.Oxcarbazepine offers a clinical advantage over carbamazepine,especially when co-administration of warfarin is required.