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頁籤選單縮合
題名 | A Case of Stevens-Johnson Syndrome Suspectedly Caused by Concurrent Use of Lamotrigine and Valproate |
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作者姓名(中文) | 高慧珍; 李炳鈺; 李榮明; | 書刊名 | 藥學雜誌 |
卷期 | 25:4=101 2009.12[民98.12] |
頁次 | 頁8-17 |
分類號 | 418.21 |
關鍵詞 | 史蒂芬強森症候群; Stevens-Johnson syndrome; Lamotrigine; Valproate; |
語文 | 英文(English) |
中文摘要 | 本文之目的在報導一位 29歲有癲癇病史的女性,並探討 lamotrigine治療如何將疾病治療複雜化而誘發史蒂芬強森症候群 (SJS)。此 29歲女性患者之前有癲癇且長期使用 valproate SR 500mg bid達12年,於 2007年9月開始至本院就診改服用 acetaminophen, valproate,及clarinase三藥。抗癲癇藥於 11月7日做調整並非緩慢減少 valproate劑量漸增 lamotrigine,反而立即改成 lamotrigine 100mg bid。很不幸的於 12月20日,她的臉及四肢出現紅斑性連合狀斑點 (erythematous confluent macules)及脫屑現象,病人本身也開始抱怨肚子痛、黏膜受損、口腔炎。 於是她入院接受治療,先將現有用藥全部停止。隔天投與 valproate (500 mg bid)來控制癲癇,再投與 methylprednisolone, cyproheptadine, levocetirizine, mometasone cream,及 vena (amp)來緩解 SJS的症狀。基於臨床觀察, acetaminophen, lamotrigine,及 clarinase均有可能引起此不良反應 (ADR),然而,只有 lamotrigine引起的 SJS在文獻中有記錄。所以 lamotrigine被懷疑是引起此 ADR之主要藥物 ,也就是說在 valproate血中濃度仍高時即投與 lamotrigine會增加 lamotrigine的消去半衰期, 而引起 lamotrigine中毒及增加有生命危險性皮膚疹的風險。因此 ,此ADR可能是 lamotirgine及valproate血中濃度並存的結果也可能是 lamotirgine單一藥物所引起。 |
英文摘要 | The purpose of this paper is to report the case of a 29-year-old woman with epilepsy, and to discuss how lamotrigine causes the complicated treatment process and induces Stevens-Johnson Syndrome (SJS). This 29-year-old female patient has a history of epilepsy, and she had been treated with valproate SR 500mg bid at one hospital for 12 years. She started to receive medication of acetaminophen, valproate, and clarinase at our hospital since Sept. 2007. Adjustment of anti-epileptic drugs was made on Nov. 7. Instead of titrating up lamotrigine slowly and decreasing dosage of valproate gradually, the patient was administered lamotrigine 100 mg bid. Unfortunately, erythematous confluent macules and desquamation over her face and limbs were noted, and the patient complained about her abdominal pain, mucosa damage and stomatitis starting on Dec. 20. She was admitted with all currently used drugs suspended. Valproate (500mg bid) was administered to control epilepsy the following day, and methylprednisolone, cyproheptadine, levocetirizine, mometasone cream, vena (amp) were given for relief of SJS. Based on the observation, acetaminophen, lamotrigine, and clarinase may all have the possibility to cause SJS. However, only lamotrigine-induced SJS was cited in the past studies. So lamotrigine is suspected to have caused this adverse drug reaction (ADR). Yet, concurrent use of lamotrigine and valproate may result in increased elimination half-life of lamotrigine, may also lead to lamotrigine toxicity and an increased risk of life-threatening rashes. Therefore, this ADR may be caused by the combination use of lamotrigine and valproate, as well as lamotrigine alone. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。