Allergic Skin Reactions to Multiple Antiepileptic Drugs

對多種抗癲癇藥物產生過敏性皮膚病變

朱晉良(Chin-Liang Chu) ； 潘志泉(Chih-Chuan Pan) ； 陸悌(Ti Lu) ； 周植強(Philip C. Chow)

《台灣精神醫學》 23卷4期 (2009/12) Pp. 331-336

https://doi.org/10.29478/TJP.200912.0009

摘要

目的：一位患有雙極性情感疾患的女性，相繼對valproic acid、lamotrigine、topiramate出現皮膚過敏反應。病例報告：六十多歲的女性第一型雙極性情感疾患病人，因為混合發作而同時服用valproic acid 700 mg/d以及lamotrigine 25 mg/d，三個禮拜之後，病患出現Stevens-Johnson syndrome。在停止上述藥物以及使用steroid治療數天後，病患症狀緩解，但當重新使用valproic acid後一天，皮膚病灶惡化。停藥一個月後，Stevens-Johnson syndrome 完全緩解。由於出現輕微躁症，我 們使用topiramate，緩慢增加劑量到200 mg/d，數天後病患出現全身搔癢的症狀，停藥改用olanzapine後過敏情形消失且精神症狀穩定。結論：Lamotrigine是9種新型抗癲癇藥物中最易出現嚴重皮膚過敏症狀的，尤其是在和valproic acid併用時，更要減緩初始劑量，拉長調整劑量時間。對多種抗癲癇藥物出現過敏的病人，第二代的抗精神病劑也是一個可以考慮的治療選擇。

並列摘要

Objective: We report a case of bipolar disorder patient who was allergic to multiple newer anti-epileptic drugs (AEDs). Case report: This 67-year-old woman patient was diagnosed as bipolar disorder for more than 20 years. At first she received valproic acid (VPA) and lamotrigine (LTG) for her mixed episode of bipolar disorder. After a three-week-combined treatment, she was diagnosed as Stevens-Johnson syndrome (SJS). We stopped all psychiatric medications and prescribed steroid. Few days later, her dermatologic symptoms were improved. When we tried to reload VPA, her dermatologic lesion was exacerbated. Therefore, we stopped VPA for one month and her dermatologic symptoms got remitted. Because of her hypomania, we prescribed topiramate (TPM) and gradually titrated to 200 mg/d. After few days, she developed intolerant general pruritus, therefore, olanzapine was given to substitute for TPM. Then, her allergic symptoms were relieved and her mental status had become stable. Conclusion: LTG has been most associated with rash of the nine newer AEDs introduced in the past decade. When prescribed with VPA, lamotrigin's initial dose and the subsequent rate of dose escalation must be lower and slower than usual, respectively. In addition, if patients have a history of allergic reaction to multiple AEDs, secondary generation antipsychotic medication may be an alternative choice.

並列關鍵字

valproic acid ； lamotrigine ； topiramate ； Stevens-Johnson syndrome

參考文獻

Naranjo CA,Busto U,Sellers EM(1981).A method for estimating the probability of adverse drug reactions.Clin Pharmacol Ther.30,239-245.

Arif H,Buchsbaum R,Weintraub D(2007).Comparison and predictors of rash associated with 15 antiepileptic drugs.Neurology.68,1701-1709.

Calabrese JR,Sullivan JR,Bowden CL(2002).Rash in multicenter trials of lamotrigine in mood disorders: clinical relevance and management.J Clin Psychiatry.63,1012-1019.

Bowden CL,Asnis GM,Ginsberg LD,Bentley B,Leadbetter R,White R(2004).Safety and tolerability of lamotrigine for bipolar disorder.Drug Saf.27,173-184.

Schlienger R,Shapiro L,Shear N(1998).Lamotrigineinduced sever cutaneous adverse reactions: systematic review.Epilepsia.39,22-26.