Sobotka J L, Alexander B, Cook B L
University of Iowa, College of Pharmacy, Iowa City 52242.
DICP. 1990 Dec;24(12):1214-9. doi: 10.1177/106002809002401214.
Early case reports of fatal hematologic effects attributed to carbamazepine (CBZ) resulted in extensive monitoring recommendations by the manufacturer. The rarity of blood dyscrasias led many authors to question the manufacturer's guidelines. Thus the manufacturer removed specific monitoring guidelines, allowing physicians to monitor CBZ using their clinical judgment. This article reviews case reports and studies of CBZ's hematologic effects. Due to their rapid onset, daily laboratory checks would be necessary to monitor for aplastic anemia, agranulocytosis, and thrombocytopenia. These adverse effects are best monitored by informing patients and physicians to carefully watch for signs and symptoms. Leukopenia develops more slowly, occurring in approximately 12 percent of children and 7 percent of adults. Its onset is typically within the first three months of treatment, with patients at risk having a low or low-normal pretreatment white blood cell (WBC) count. Leukopenia often reverses, even if CBZ is continued. Based upon our review of the literature, we recommend monitoring of those high-risk patients during the first three months of treatment with the frequency being determined by results of each laboratory value. WBC counts less than 3000/mm3 or neutrophil counts below 1000/mm3 warrant a decrease in dose with frequent monitoring or CBZ discontinuation, if necessary.
卡马西平（CBZ）所致致命血液学效应的早期病例报告导致制造商提出了广泛的监测建议。血液系统疾病的罕见性使得许多作者对制造商的指南提出质疑。因此，制造商取消了具体的监测指南，允许医生根据临床判断对CBZ进行监测。本文回顾了关于CBZ血液学效应的病例报告和研究。由于这些不良反应起病迅速，因此有必要每日进行实验室检查以监测再生障碍性贫血、粒细胞缺乏症和血小板减少症。告知患者和医生仔细留意体征和症状是监测这些不良反应的最佳方法。白细胞减少症发展较为缓慢，在大约12%的儿童和7%的成人中出现。其发病通常在治疗的前三个月内，有风险的患者治疗前白细胞（WBC）计数较低或略低于正常水平。即使继续使用CBZ，白细胞减少症通常也会逆转。基于我们对文献的回顾，我们建议在治疗的前三个月对那些高危患者进行监测，监测频率由每次实验室检查结果决定。白细胞计数低于3000/mm³或中性粒细胞计数低于1000/mm³时，如有必要，应减少剂量并频繁监测，或停用CBZ。
