1例卡培他滨致严重不良反应患者的治疗药物监测.pdfVIP

中国药物应用与监测 2015 年12月第12卷第6 期 Chinese Journal of Drug Application and Monitoring, Vol.12, No.6, December 2015 1 例卡培他滨致严重不良反应患者的治疗药物监测 李 然，焦园园，刘 颖，马 旭，张艳华（北京大学肿瘤医院暨北京市肿瘤防治研究所药剂科，恶性肿瘤发病机制及转化研究 教育部重点实验室，北京 100142 ） [摘要] 1例患者在应用卡培他滨化疗后出现了严重黏膜毒性，诱发多器官功能损伤的严重不良反应。临床药师结合临床诊 -1 ，考虑可能存在代谢障碍，建议患者 治，对该患者进行了治疗药物监测（TDM ），经检测患者血浆氟尿嘧啶浓度为181 ng·mL 进行血液滤过治疗，临床医生予以采纳，经对症治疗患者症状好转后转院。 [关键词] 卡培他滨；血药浓度；治疗药物监测；药品不良反应 [ 中图分类号] R979.1 [ 文献标识码] A [ 文章编号] 1672 – 8157(2015)06 – 0354 – 03 Therapeutic drug monitoring in a patient with severe adverse reactions induced by capecitabine LI Ran, JIAO Yuan-yuan, LIU Ying, MA Xu, ZHANG Yan-hua(Department of Pharmacy, Peking University Cancer Hospital Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China) [ABSTRACT] We reported a case of severe adverse effect after capecitabine administration. This patient experienced severe mucous toxicity and multiple organ dysfunctions. In order to figure out the causes of this severe toxicity, therapeutic drug monitoring (TDM) analysis of serum 5-FU was conducted to determine capecitabine exposure by clinical pharmacists. The serum 5-FU level was 181 ng mL-1 3 weeks after capecitabine discontinuation, which implied the existence of metabolic dysfunction of capecitabine in this · case. Thus, clinical pharmacists suggested using of hemofiltration for eliminating the excess of 5-FU. The toxic symptoms gradually improved after hemofiltration. In this case, clinical pharmacists provided pharmaceutical care on TDM analysis, critical information in determining the causation between drug exposure and toxicity as well as specific treatment regimen. After the symptomatic treatment, the patient was discharged with the improved condition. [KEY WORDS] Capecitabine; Blood drug concentration; T