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卡马西平—10,11—环氧化物(CBZ-E)是卡马西平(CBZ)最重要的代谢产物。在儿童中,这种环氧化物和CBZ一起具有抗癫痫的作用。在成人中,有报道拉莫三嗪(LTG)可能增加CBZ-E浓度而引起CBZ毒性。但这种假设目前尚未得到证实。作者就儿童病人中这两种抗癫痫药(AED)的药代动力学之间是否有相互作用进行了研究。 作者调查了患难治性癫痫的11例儿童和3例青少年(6～22岁)的CBZ和CBZ-E血浆浓度。所有患者均服用AED一年以上,其中3例单用CBZ,6例用CBZ加另一种AED,5例用CBZ加其他二种AED联合治疗。三组均加用LTG,开始时剂量为Img/kg/d,每天2次,每隔1周剂量增加1mg/kg/d,直至出现临床反应或观察到副作用。试验期间保持CBZ和其他AED血浆浓度恒定。
Carbamazepine-10,11-epoxide (CBZ-E) is the most important metabolite of carbamazepin (CBZ). In children, this epoxide has antiepileptic effects together with CBZ. In adults, it has been reported that lamotrigine (LTG) may increase CBZ-E concentration causing CBZ toxicity. However, this assumption has not yet been confirmed. The authors studied whether there is an interaction between the pharmacokinetics of the two antiepileptic drugs (AEDs) in pediatric patients. The authors investigated CBZ and CBZ-E plasma concentrations in 11 children with refractory epilepsy and 3 adolescents (6-22 years of age). All patients took AED for more than one year. Among them, 3 were CBZ alone, 6 were CBZ plus another AED, and 5 were treated with CBZ plus two other AEDs. All three groups received LTG, initially at a dose of 1 mg / kg / d twice daily and 1 mg / kg / d every other week until clinical responses or side effects were observed. The plasma concentration of CBZ and other AEDs is kept constant during the experiment.