# 一名病人穩定使用lamotrigine 200 mg/day維持治療1年，表示7天露營期間漏服所有劑量。今天沒有新症狀。護理師最佳指示是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391749&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一名病人穩定使用lamotrigine 200 mg/day維持治療1年，表示7天露營期間漏服所有劑量。今天沒有新症狀。護理師最佳指示是什麼？

## 選項

1. 今晚恢復200 mg維持劑量
2. 今天一次服下所有漏服劑量
3. 下一劑加倍以補回
4. 在醫療人員指導下以慢速加量時程重新開始；漏服超過5天需重新加量以避免SJS **✔ 正確答案**

**正確答案: 4**

## 解析

正解 (2): Lamotrigine若漏服超過5天，必須重新開始慢速加量時程。突然恢復維持劑量會有與初始快速加量相同的SJS風險。(1) 直接恢復有皮疹風險。(3) 加倍會增加毒性。(4) 一次補服不安全。

## 深入解析

記憶提示 Lamotrigine「5天規則」：漏服>5天需重新加量。病人衛教 旅行時不可斷藥，需攜帶備用藥。

## 臨床情境

情境 30歲女性因局部癲癇服用lamotrigine 200 mg/day已1年。露營期間連續7天漏服所有劑量；今天無症狀。

## 重要概念

- **漏服處理流程** — Lamotrigine特有規則：漏服超過5天需重新加量以避免SJS。
- **維持劑量** — 加量後持續的穩定目標劑量；lamotrigine依適應症與併用藥約100-400 mg/day。
- **服藥遵從性衛教** — 強調長時間中斷後不可直接以全劑量重新開始lamotrigine。

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