Berei Theodore J, Lillyblad Matthew P, Almquist Adrian K
1 Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
2 Department of Pharmacy, Abbott Northwestern Hospital, Minneapolis, MN, USA.
J Pharm Pract. 2018 Apr;31(2):222-226. doi: 10.1177/0897190017700557. Epub 2017 Mar 27.
Lacosamide is a new-generation antiepileptic drug (AED) most commonly used adjunctively in the setting of partial-onset seizures refractory to traditional therapy. We describe the first case report, to our knowledge, of a patient who developed recurrent, sustained ventricular tachycardia with multiple administrations of lacosamide in an acute setting. A 70-year-old woman with a history significant for valvular heart disease was admitted to the inpatient cardiology service for worsening heart failure. On hospital day 7, she received a bioprosthetic aortic valve. Prior to surgery and immediately after, the patient's electrocardiogram (ECG) was normal. After developing multiple generalized tonic-clonic seizures refractory to levetiracetam, fosphenytoin, and valproic acid, the decision was made to initiate lacosamide. Two hours following the second lacosamide dose, the patient developed a wide complex QRS that transitioned into sustained ventricular tachycardia requiring electrical cardioversion. Sustained ventricular tachycardia occurred again, just hours after the third dose of lacosamide was given. Following cessation of lacosamide, the patient's QRS interval normalized and has since had no documented episodes of ventricular tachycardia. Clinicians should be aware of the potential for life-threatening rhythmic disturbances in patients initiated on lacosamide and the need for vigilant ECG, electrolyte, and drug-drug monitoring.
拉科酰胺是一种新一代抗癫痫药物（AED），最常用于传统治疗难治的部分性发作癫痫的辅助治疗。据我们所知，我们描述了首例在急性情况下多次使用拉科酰胺后出现反复持续性室性心动过速的患者病例报告。一名有显著瓣膜性心脏病病史的70岁女性因心力衰竭加重入住心内科病房。住院第7天，她接受了生物人工主动脉瓣置换术。手术前及术后即刻，患者心电图（ECG）正常。在出现对左乙拉西坦、磷苯妥英和丙戊酸难治的多次全身性强直阵挛发作后，决定开始使用拉科酰胺。第二次服用拉科酰胺两小时后，患者出现宽QRS波群，继而转变为持续性室性心动过速，需要进行电复律。在第三次服用拉科酰胺数小时后，再次出现持续性室性心动过速。停用拉科酰胺后，患者的QRS间期恢复正常，此后未再有室性心动过速发作的记录。临床医生应意识到开始使用拉科酰胺的患者可能出现危及生命的节律紊乱，以及进行警惕的心电图、电解质和药物相互作用监测的必要性。
