Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL, United States.
Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, FL, United States.
Curr Drug Saf. 2020;15(2):156-159. doi: 10.2174/1574886315666200225111057.
Lamotrigine is a phenyltriazine medication that has been approved by the United States Food and Drug Administration as monotherapy and as an adjunctive agent for the treatment of seizure disorder. It was later approved by the FDA for the treatment of bipolar disorder. Lamotrigine is generally well tolerated by patients, but some serious symptoms can occur during treatment. These severe side effects include rashes and multi-organ failure. Lamotrigine has also been associated with the development of mental status changes, frequently when used concurrently with other medications that may impact the metabolism of lamotrigine.
To present the case of a 65-year-old man being treated with lamotrigine and valproic acid who developed mental status changes after the addition of sertraline to his medication regimen, and to compare this case to existing cases reported in the literature.
Our case adds to the existing literature by demonstrating that patients may experience adverse medication effects despite lamotrigine levels that are normally considered to be in the therapeutic range, highlighting the importance of clinical correlation when obtaining medication levels.
Clinicians should use caution interpreting lamotrigine levels when working up delirium, as normal levels may not rule out the development of lamotrigine toxicity.
拉莫三嗪是一种苯并二氮杂䓬类药物，已被美国食品和药物管理局批准用于治疗癫痫发作的单药治疗和辅助治疗。后来，它被 FDA 批准用于治疗双相情感障碍。拉莫三嗪通常被患者耐受良好，但在治疗过程中可能会出现一些严重症状。这些严重的副作用包括皮疹和多器官衰竭。拉莫三嗪还与精神状态改变的发展有关，通常发生在与可能影响拉莫三嗪代谢的其他药物同时使用时。
介绍一例正在接受拉莫三嗪和丙戊酸钠治疗的 65 岁男性，在加用舍曲林后出现精神状态改变的病例，并与文献中报告的现有病例进行比较。
我们的病例通过证明即使拉莫三嗪水平通常被认为在治疗范围内，患者也可能出现不良药物作用，从而增加了现有文献，突出了在获得药物水平时进行临床相关性的重要性。
当对谵妄进行检查时，临床医生在解释拉莫三嗪水平时应谨慎，因为正常水平并不能排除拉莫三嗪毒性的发展。
