丙戊酸钠联合拉莫三嗪致药疹1例分析

Analysis of One Case of Drug Eruption Induced by Sodium Valproate Combined with Lamotrigine

摘要: 目的：探讨丙戊酸钠联合拉莫三嗪致药疹的临床特征及发生机制。方法：回顾性分析1例青年男性联合用药后皮疹的演变及治疗护理过程。结果：患者因口服丙戊酸钠缓释片0.5 g bid癫痫控制不佳，高起始剂量加用拉莫三嗪片25 mg bid控制癫痫症状，用药17天后，患者颜面部、颈部及躯干出现大面积散在淡红色斑丘疹，抗过敏治疗后患者皮疹进行性扩大，停用拉莫三嗪予以糖皮质激素治疗后皮疹好转，根据我国药品不良反应监测中心制定的关联性评价标准及Naranjo量表评分其因果关系为：很可能相关。停用拉莫三嗪后半年，随访患者无皮疹复发。结论：该案例凸显了丙戊酸钠与拉莫三嗪联用时，严格遵守推荐的起始剂量和缓慢递增剂量至关重要。临床医师在选择联合治疗时，须充分权衡疗效与严重皮肤不良反应的风险，并对患者，特别是沟通困难的精神科患者，进行系统且频繁的皮肤监测。

Abstract: Objective: This paper aims to investigate the clinical characteristics and underlying mechanisms of drug eruption induced by the combination of sodium valproate and lamotrigine. Methods: A retrospective analysis was conducted on the evolution of rash and the treatment and nursing process in a young male patient following combined administration of the two drugs. Results: The patient received oral sodium valproate extended-release tablets (0.5 g twice daily) due to poor seizure control. Lamotrigine tablets (25 mg twice daily) were added to manage epileptic symptoms. Seventeen days after the initiation of lamotrigine, the patient developed extensive, scattered, light-red maculopapular rash on the face, neck, and trunk. Antiallergic treatment failed to prevent progression of the rash. After discontinuation of lamotrigine and administration of glucocorticoid therapy, the rash gradually improved. According to the causality assessment criteria established by the China National Center for Adverse Drug Reaction Monitoring and the Naranjo probability scale, the causal relationship was classified as “probable”. Six months after lamotrigine withdrawal, follow-up revealed no recurrence of the rash. Conclusion: This case highlights the critical importance of strictly adhering to the recommended starting dose and slow dose escalation when combining sodium valproate and lamotrigine. When selecting combination therapy, clinicians must carefully weigh the therapeutic benefits against the risk of severe cutaneous adverse reactions, and perform systematic and frequent skin monitoring, especially in psychiatric patients who may have difficulty communicating.