# 護理師查看一名已使用valproate病人要開始lamotrigine的醫囑。關於lamotrigine加量時程，最重要的調整是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391748&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

護理師查看一名已使用valproate病人要開始lamotrigine的醫囑。關於lamotrigine加量時程，最重要的調整是什麼？

## 選項

1. 將lamotrigine劑量加倍，因為valproate會加速代謝
2. 使用較慢加量時程，約為平常起始與目標劑量的一半，因為valproate抑制glucuronidation而提高lamotrigine濃度 **✔ 正確答案**
3. 不需調整，使用標準加量時程
4. 開始lamotrigine前先停用valproate

**正確答案: 2**

## 解析

正解 (2): Valproate是強效glucuronidation抑制劑，會使lamotrigine濃度幾乎加倍，大幅增加SJS/TEN風險。併用時lamotrigine起始劑量與目標劑量約需減半，且加量時間延長。(1) 標準時程增加皮疹與SJS風險。(3) 方向錯誤，valproate是抑制不是誘導。(4) 停用valproate可能使情緒不穩。

## 深入解析

記憶提示 Lamotrigine + Valproate = “Half-and-Slow”：半量、慢加。Carbamazepine、phenytoin則相反會誘導，lamotrigine需要較高劑量。

## 臨床情境

情境 42歲男性，因雙相情緒障礙服用valproate 1000 mg/day已2年。因情緒症狀突破，醫囑加入lamotrigine。

## 重要概念

- **Glucuronidation** — 肝臟第二相代謝途徑；valproate抑制此途徑，使lamotrigine濃度上升。
- **酵素抑制** — 併用藥物代謝下降，導致血中濃度與毒性風險上升。
- **Lamotrigine劑量調整** — 併用valproate時半量且慢加；併用carbamazepine/phenytoin等誘導劑時目標劑量較高。

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