Besag F M
St Piers Lingfield, Surrey, UK.
J Intellect Disabil Res. 1998 Dec;42 Suppl 1:50-6.
Information about the mechanism of action and pharmacology of lamotrigine is summarized. A brief review of the literature on the use of this drug in people with intellectual disability is followed by a suggested framework for evaluating antiepileptic drugs in this population. The role of lamotrigine is systematically examined against the suggested framework. This leads to the conclusion that lamotrigine is a very favourable drug for treating epilepsy in people with intellectual disability because it has a broad spectrum of action, is effective in treating subtle seizures, shows no loss of effect with time, is not usually sedative, does not produce difficult-to-manage adverse effects, appears to have no direct adverse behavioural effects and is available in a range of 'patient friendly' preparations. However, it is important to use the drug wisely. This implies starting with low doses of lamotrigine and escalating the dose slowly to avoid adverse effects, especially rash, and being aware of drug interactions which could cause difficulty, including the prolongation of half-life with valproate, the pharmacodynamic interaction when it is added to carbamazepine and the pharmacokinetic interactions of lamotrigine with a number of antiepileptic drugs.
本文总结了拉莫三嗪的作用机制和药理学信息。在简要回顾有关该药物在智力残疾人群中使用的文献后，提出了一个评估该人群抗癫痫药物的建议框架。依据该建议框架，系统地研究了拉莫三嗪的作用。由此得出结论，拉莫三嗪是治疗智力残疾人群癫痫的一种非常理想的药物，因为它作用谱广，对细微发作有效，不会随时间推移而疗效丧失，通常无镇静作用，不会产生难以处理的不良反应，似乎没有直接的不良行为影响，并且有多种“患者友好型”制剂。然而，明智地使用该药物很重要。这意味着从低剂量的拉莫三嗪开始，缓慢增加剂量以避免不良反应，尤其是皮疹，并注意可能导致问题的药物相互作用，包括与丙戊酸盐合用时半衰期延长、与卡马西平合用时的药效学相互作用以及拉莫三嗪与多种抗癫痫药物的药代动力学相互作用。
