Kaufman K R, Gerner R
Department of Psychiatry, UMDNJ-RWJMS, New Brunswick, NJ 08901, USA.
Seizure. 1998 Apr;7(2):163-5. doi: 10.1016/s1059-1311(98)80074-5.
Blood level monitoring helps to determine the therapeutic and toxic ranges for anticonvulsants and antidepressants. We investigated initial drug-drug interactions between lamotrigine and sertraline. We report on case histories of two epileptic patients who were initially on lamotrigine and to whom sertraline was added to control psychiatric features. In case 1, a total daily dose of 25 mg sertraline, with nondetectable sertraline and desmethylsertraline blood levels, resulted in a doubling of the lamotrigine blood level with symptoms of toxicity. In case 2, a 25 mg reduction in the total daily dose of sertraline resulted in halving of the lamotrigine blood level even though the lamotrigine dosage was increased by 33%. This shows that sertraline has potent interactions with lamotrigine metabolism. The authors hypothesize that inhibition of glucuronidation is responsible. Clinicians are advised to observe for symptoms of toxicity and to do serial blood levels to monitor this interaction.
血药浓度监测有助于确定抗惊厥药和抗抑郁药的治疗范围及中毒范围。我们研究了拉莫三嗪与舍曲林之间最初的药物相互作用。我们报告了两名癫痫患者的病例史，这两名患者最初服用拉莫三嗪，后来加用舍曲林以控制精神症状。在病例1中，每日总剂量25mg的舍曲林，其血药浓度及去甲基舍曲林血药浓度均未检测到，但拉莫三嗪血药浓度却翻倍并出现了中毒症状。在病例2中，舍曲林每日总剂量减少25mg，尽管拉莫三嗪剂量增加了33%，但其血药浓度却减半。这表明舍曲林与拉莫三嗪代谢存在显著的相互作用。作者推测这是由葡萄糖醛酸化抑制所致。建议临床医生观察中毒症状并进行系列血药浓度监测以监测这种相互作用。
