拉莫三嗪的血液系统不良反应

拉莫三嗪所致血液系统不良反应主要包括外周血白细胞、中性粒细胞、血小板减少及弥漫性血管内凝血，但无明显临床症状。该不良反应的机制尚不明确，其主要危险因素包括联用其他抗癫痫药物、起始剂量超过推荐值和药物增量速度过快等。在初始应用拉莫三嗪及随后逐渐加量的过程中，须警惕可能存在的血液系统不良反应。治疗时不应单纯依据外周血白细胞计数决定是否停药或换药，若骨髓检查正常或骨髓前体细胞与红细胞系前体细胞比例增高，药物仍可继续应用；若上述比例减少或中性粒细胞计数≤0.5×109/ L，则应停药或换药。对于既往患血小板减少症、白细胞减少症者应定期监测，至少每季度进行1次实验室检查。给予此类患者行外科手术应尤其慎重，应进行术前血小板功能检查。

Hematologic adverse reactions caused by lamotrigine

The hematological adverse reactions caused by lamotrigine includes decreasing count of white blood cell,neutrophil,and platelet,as well as disseminated intravascular coagulation. However, patient will not develop obvious clinical symptom. The mechanism of this adverse reactions is not clear and the risk factors include mainly concomitant use of other antiepileptic drugs,initial dose exceeding the recommended dose,too fast dose escalation,and so on. In the initial application and the process of gradually added count of lamotrigine,possible hematological adverse reactions must be alerted. The decision of drug discontinuation and changing should not be simply made only on the basis of leukocyte count. If the examination of bone marrow smear is normal or the ratio of bone marrow precursor cell to precursor cell of red blood cell increases,the drug can still be given. If the above ratio decreases or the level of neutrophil count is less than or equal to 0. 5 × 109 / L,the drug should be stopped or switched to other medication. These patients who ever had thrombocytopenia or leucopenia should be monitored regularly and should be treated with the laboratory test once every quarter at least. The surgery should be given very carefully to these patients and platelet function should be examined preoperatively.