# 一名年輕女性因癲癇穩定使用 carbamazepine，回報非計畫性懷孕。關於其避孕史，哪項說法最正確？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391744&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名年輕女性因癲癇穩定使用 carbamazepine，回報非計畫性懷孕。關於其避孕史，哪項說法最正確？

## 選項

1. 「懷孕可能治癒癲癇，所以現在可以停用carbamazepine。」
2. 「Carbamazepine會誘導CYP3A4，加速COC代謝；治療期間需要非荷爾蒙或較高劑量避孕方式。」 **✔ 正確答案**
3. 「複方口服避孕藥效果不受抗癲癇藥影響。」
4. 「COC失敗是因為你漏服，除此之外沒有其他方法能預防。」

**正確答案: 2**

## 解析

正解 (2): Carbamazepine 是強效CYP3A4誘導劑且具自我誘導，會加速含雌激素避孕藥代謝、降低效果。使用酵素誘導型抗癲癇藥的女性需較高雌激素COC、銅IUD、depot medroxyprogesterone或屏障法。(1) 錯誤責怪病人。(3) 懷孕不會治癒癲癇。(4) 效果會明顯下降。

## 深入解析

記憶提示 酵素誘導型抗癲癇藥（phenytoin、carbamazepine、phenobarbital、topiramate >200 mg）會降低荷爾蒙避孕效果。較安全選擇：銅IUD、depot MPA、levonorgestrel IUD。

## 臨床情境

情境 24歲女性，因局部癲癇已服用carbamazepine 200 mg PO BID 18個月。同時使用複方口服避孕藥（COC）。雖規律服用COC，現已懷孕8週。

## 重要概念

- **CYP3A4誘導** — 提高CYP3A4酵素活性，加速併用藥物代謝；carbamazepine是強誘導劑。
- **自我誘導** — Carbamazepine在2-4週內誘導自身代謝；血中濃度可能下降並需要調整劑量。
- **藥物-避孕交互作用** — 與酵素誘導藥併用時，荷爾蒙避孕藥效果下降。

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