合并抗癫痫药物对癫痫患儿拉莫三嗪血药浓度的影响  

Influence of Concomitant Antiepileptic Drugs on Lamotrigine Plasma Concentration in Children with Epilepsy

作　　者：和凡 何艳玲 祁俊华 杨彤 

机构地区：[1]广州市妇女儿童医疗中心,广东广州510120

出　　处：《儿科药学杂志》2013年第9期33-36,共4页Journal of Pediatric Pharmacy

基　　金：广州市医药卫生科技项目(编号:201102A213030);广东省医院药学研究基金(编号:2011A13)

摘　　要：目的：探讨合并抗癫痫药对癫痫患儿拉莫三嗪（LTG）血药浓度的影响。方法：收集癫痫患儿相关血药浓度数据107例，根据LTG单用或合并用药的情况分成4组：单用LTG（T1）、LTG＋丙戊酸钠（VAP）（他）、LTG＋卡马西平（CBZ）（T3）、岍G＋VAP＋CBZ（T4）。LC／MS／MS测定LTG稳态血药浓度，计算浓度剂量比值（C／D），对各组别数据进行分析。结果：LTG单用组的C／D值为0．73±0．16。合用VAP能显著提高LTG的浓度，C／D值为1．26±0．55，合用CBZ则显著降低LTG的浓度，C／D值为0．32±0．21．各组比较差异有统计学意义（P〈0．05）。〈5岁组患儿C／D值低于5～10岁组和〉10岁组，差异无统计学意义（P〉0．05）。性别对LTG的血药浓度没有影响。结论：LTG的血药浓度受合并用药和患儿年龄的影响，临床使用时需要根据具体情况调整剂量，但LTG的治疗药物监测可以不作为常规监测项目。Objective： To explore the influence of concomitant antiepileptic drugs （AEDs） on the plasma concentration of lamotrigine （LTG） in children with epilepsy. Methods： A total of 107 concentration data were classified into four groups according to their concomitant AEDs. LTG steady plasma concentrations were determined by LC/MS/MS. The concentration to dose ratio （ C/D ） was calculated. Each category data were analyzed. Results： The C/D value for LTG monotherapy was 0.73± 0. 16. When LTG was combined with valproic acid （VPA） , the C/D value increased to 1.26±0.55; when it was combined with carbamazepine （CBZ）, the C/D value reduced to 0.32±0.21, with significant differences （P〈0.05）. The C/D value in younger children （〈5 years） was lower than that in older children, but the difference was not significant. Gender did not influence LTG concentration. Conclusions： Concomitant with VPA or CBZ and age influenced the plasma concentration of LTG; it was necessary to regulate the LTG regimen with different situations. Therapeutic drug monitoring （TDM） of lamotrigine is not recommended as a tool for routine dose adjustment.

关 键 词：拉莫三嗪 丙戊酸钠 卡马西平 血药浓度－剂量比值 

分 类 号：R969.3[医药卫生—药理学]