Porter R J
Medical Neurology Branch, National Institute of Neurological and Communicative Disorders & Stroke, Bethesda, MD 20892.
Epilepsia. 1987;28 Suppl 3:S59-63. doi: 10.1111/j.1528-1157.1987.tb05779.x.
Appropriate use of carbamazepine for the treatment of epilepsy is based on correct identification of the patient's seizure type. Carbamazepine is effective against partial seizures and against generalized tonic clonic seizures. Therapy should begin gradually, with initial doses increased slowly over 1 or 2 weeks, as tolerated. Side effects include fatigue, dizziness, ataxia, double vision, nausea, and vomiting. Most practitioners agree that, because of carbamazepine's relatively short half-life, the total dosage should be administered in at least two divided doses. This avoids too high a peak blood level that would occur with a single dose. Carbamazepine therapy is associated with the development of two hematologic conditions. Leukopenia, which may be transient or persistent, requires careful monitoring but is not cause for immediate discontinuation of therapy. Aplastic anemia occurs rarely but is potentially fatal, and therefore diligent monitoring of hematologic function is indicated. Aplastic anemia is an idiosyncratic, non-dose-related side effect that is most likely to occur within the first 3 or 4 months of initiating therapy. Once seizures are controlled, plasma levels of carbamazepine should be measured to establish optimum levels for individual patients being treated with this drug.
卡马西平用于治疗癫痫的合理应用基于对患者癫痫发作类型的正确识别。卡马西平对部分性发作和全身性强直阵挛性发作有效。治疗应逐渐开始，初始剂量在1至2周内根据耐受情况缓慢增加。副作用包括疲劳、头晕、共济失调、复视、恶心和呕吐。大多数从业者认为，由于卡马西平的半衰期相对较短，总剂量应至少分两次服用。这可避免单次给药导致的血药浓度峰值过高。卡马西平治疗与两种血液系统疾病的发生有关。白细胞减少症可能是短暂的或持续的，需要仔细监测，但并非立即停药的原因。再生障碍性贫血很少发生，但可能致命，因此需要对血液功能进行密切监测。再生障碍性贫血是一种特异质性、与剂量无关的副作用，最有可能在开始治疗的前3或4个月内出现。一旦癫痫发作得到控制，应测量卡马西平的血药浓度，以确定接受该药物治疗的个体患者的最佳血药浓度。
