1例伊马替尼致胃肠道间质瘤术后多浆膜腔积液患者的个体化治疗实践  

Clinical Pharmacist′s Participation in the Individual Treatment for a Patient with Multiple Serous Cavity Effusion Caused by Imatinib After Gastrointestinal Stromal Tumor Surgery

作　　者：李厚丽 张迪[1] 马师洋[2] 安梦娜 王娜[2] LI Houli;ZHANG Di;MA Shiyang;AN Mengna;WANG Na(The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi,China 710061;The Second Affiliated Hospital of Xi′an Jiaotong University,Xi′an,Shaanxi,China 710004)

机构地区：[1]西安交通大学第一附属医院,陕西西安710061 [2]西安交通大学第二附属医院,陕西西安710004

出　　处：《中国药业》2024年第21期121-125,共5页China Pharmaceuticals

基　　金：西安交通大学第一附属医院科研发展基金自由探索创新项目[2021ZYTS-33]。

摘　　要：目的促进伊马替尼的临床安全应用。方法临床药师参与1例伊马替尼致胃肠道间质瘤(GIST)切除术后多浆膜腔积液患者的临床诊疗过程,结合患者的病史、用药史,并通过治疗药物监测(TDM)反馈伊马替尼的稳态血药浓度谷值(Cssmin)进行药品不良反应关联性评价。对症治疗后,患者重启伊马替尼治疗,继续基于TDM和疗效调整伊马替尼给药剂量。结果患者停用伊马替尼48 h后,伊马替尼的血药浓度为1556.8 ng/mL,预测其Cssmin为3913.8 ng/mL,远高于GIST的推荐治疗浓度(1100 ng/mL);继续予利尿治疗,病情缓解后带药出院。经8次伊马替尼TDM,调整剂量为每天1次,每次0.2 g,血药浓度稳定在1700 ng/mL左右。结论临床药师利用TDM调整伊马替尼的剂量,可促进临床GIST患者安全使用伊马替尼。Objective To promote the safe clinical application of imatinib.Methods A clinical pharmacist participated in the clinical diagnosis and treatment process of a patient with multiple serous cavity effusion caused by imatinib after gastrointestinal stromal tumor(GIST)surgery.Based on the patient′s medical history and medication history,and the steady-state plasma-concentration(Cssmin)of imatinib was fed back through therapeutic drug monitoring(TDM)to evaluate the association between the drug and adverse drug reactions.Imatinib treatment was restarted after symptomatic treatment,and the dose of imatinib was adjusted based on TDM and efficacy.Results The concentration of imatinib was 1556.8 ng/mL after 48 h drug withdrawal,and the predicted Cssmin was 3913.8 ng/mL,which was much higher than the recommended therapeutic concentration of GIST(1100 ng/mL).The patient was relieved after receiving diuretic treatment,and discharged with imatinib.After eight times of TDM,the administration scheme of the drug was optimized as 0.2 g each time,once a day,and the plasma concentration was stable at about 1700 ng/mL.Conclusion Clinical pharmacists using TDM to adjust the dose of imatinib can promote clinic safe use of imatinib in GIST patients.

关 键 词：伊马替尼 胃肠道间质瘤 多浆膜腔积液 治疗药物监测 临床药师 个体化治疗 

分 类 号：R969.4[医药卫生—药理学] R979.1[医药卫生—药学]