1例急性淋巴细胞白血病患儿使用泮托拉唑延迟大剂量甲氨蝶呤排泄的药学监护

Pharmaceutical care of an acute lymphoblastic leukemia child with pantoprazole-caused excretion delay of high-dose methotrexate

目的观察1例急性淋巴细胞白血病(ALL)患儿接受4周期大剂量甲氨蝶呤(HDMTX)巩固化疗的经过,探讨在治疗儿童ALL中质子泵抑制剂(PPI)延迟HDMTX排泄的解决方案和药学监护。方法通过监测MTX血药浓度指导亚叶酸钙解救,分析患儿使用泮托拉唑延迟HDMTX化疗排泄的情况。结果本案例中,患儿第1周期未出现HDMTX延迟排泄,第2、3周期出现了明显的延迟排泄,并发生了相关不良反应事件(肝损害、黏膜炎)。第4周期采用西咪替丁替代泮托拉唑后未发生HDMTX延迟排泄。结论PPIs可致HDMTX延迟排泄风险增加,H2受体拮抗剂(H2RA)在降低HDMTX延迟排泄风险方面可能优于PPIs。

Objective To observe a child with acute lymphoblastic leukemia(ALL)who received four cycles of high-dose methotrexate(HDMTX)consolidation chemotherapy,and to explore the solution and pharmaceutical care of proton pump inhibitors(PPIs)in delaying HDMTX excretion during the treatment of ALL in children.Methods The calcium folinate rescue was guided by monitoring the blood concentration of MTX,and the delayed excretion of HDMTX caused by pantoprazole in chemotherapy was analyzed.Results In this case,there was no delayed excretion of HDMTX in the first cycle,but in the second and third cycles,obvious delayed excretion and related adverse reaction events(liver damage,mucositis)occurred.In the fourth cycle,there was no delayed excretion of HDMTX after cimetidine replaced pantoprazole.Conclusion PPIs can increase the risk of delayed excretion of HDMTX,and H2 receptor antagonist(H2RA)may be superior to PPIs in reducing the risk of excretion delay of HDMTX.