第二代抗精神病藥物非核准處方用藥

Off-label Uses of Second-generation Antipsychotic Drugs

由於精神藥物治療的神速研究發展，使我們更進一步，對各種精神科疾病了解。第二代 抗精神病藥物上市以後，由於大量使用，目前已經大部份取代了第一代抗精神病藥物。最主 要是由於第二代抗精神病藥物，比較不會引起具有損傷性的徑外錐體副作用。這些第二代抗 精神病藥物不只證實對精神分裂症治療有療效，而且對其他精神疾病治療也有臨床試驗。美 國食品及藥物管理局 (Food and Drug Administration，FDA) 也核准第二代抗精神病藥用來治 療精神分裂症、雙極性疾患、自閉症及重度型憂鬱症的病人。臨床醫師對這些第二代抗精神 病藥物多功能性的發現，促使對這些疾病做更進一步的研究及探討。許多臨床醫師目前對一 些非核准的臨床適應症，也發現第二代抗精神病藥物，也有相當好的治療效果及副作用耐受 性。這些一些非核准的臨床適應症，包括用來治療妥瑞症、創傷後壓力疾患、注意力缺乏／ 過動症、口給、強迫症等。在這篇綜論中，作者整理美國 FDA 核准過用第二代抗精神病藥 物，用來治療精神分裂症、雙極性疾患、自閉症及重度型憂鬱症的病人的最新資料，及探討 目前用於非核准的臨床適應症最新臨床證據。

Pharmacotherapy in the area of psychiatry has continued to rapidly evolve as we gain a greater understanding of psychopathology in various mental illnesses. Since the advent of the second-generation antipsychotic (SGA) or atypical antipsychotic drugs, they have largely replaced the use of its fi rst generation predecessors in the treatment of schizophrenia. This change is primarily attributed to the benefi t that SGAs do not carry as high a risk in causing detrimental extrapyramidal adverse effects. These SGAs have not only proven to be effi cacious in the treatment of schizophrenia, but their benefi t has also been investigated and some SGAs recognized by the U.S. Food and Drug Administration (FDA) for use in the treatment of bipolar disorder, autism, and major depressive disorder (MDD). The discovery by scientists and clinicians of the versatility of SGA treatment in various psychiatric disorders has prompted a call for further research in such disorders. Many clinicians currently use SGAs in an off-label manner with the belief of suffi cient evidence to suggest effi cacy and favorable tolerability. In addition to similar SGA off-label use in bipolar disorder, autism, and major depressive disorder, the greatest evidence for off-label use of SGAs currently lies in the treatment of Tourette’s syndrome, posttraumatic stress disorder, attention defi cit hyperactivity disorder-associated aggression, generalized anxiety disorder, stuttering, and potentially obsessive-compulsive disorder. This overview provides clinicians with a summary of current status of information in regards to the FDA-approved and off-label uses of SGAs in conditions other than schizophrenia, bipolar disorder, autism, and MDD.