从1例肺癌伴疼痛患者探讨克唑替尼与阿片类止痛药物的相互作用

Investigation of the interaction between crizotinib and opioid analgesics through a lung cancer patient with pain

1例肺癌伴疼痛男性患者,因确诊"左肺腺癌多发骨转移1年余"入院,入院后同时服用克唑替尼与阿片类止痛药物。临床药师结合相关资料分析克唑替尼与不同止痛药物之间的相互作用、临床意义及防治措施。根据相关研究文献分析,芬太尼透皮贴在小剂量缓慢释放的止痛剂量下,受到克唑替尼影响产生显著临床意义的可能性小。该患者更换为芬太尼透皮贴后未出现呼吸抑制症状,且便秘反应明显减轻。提示临床药师遇到酶抑制剂与酶底物同时使用的医嘱时,不应一律否定,而应根据药物特性、剂量以及用药安全等方面权衡利弊。

One male lung cancer patient with pain was hospitalized for left lung adenocarcinoma with multiple bone metastases more than one year. Crizotinib and opioid analgesics were taken simultaneously by the patient after admission. Clinical pharmacists analyzed drug interactions, clinical significance and prevention measures between crizotinib and opioid analgesics according to relevant reference data. According to research literature, we inferred a small dose slow-release fentanyl transdermal patches which only play analgesic role produced small possibility of clinical significance by the impact of crizotinib. The patient didn＇t appear respiratory depression symptoms and constipation significantly reduced when he was administrated with fentanyl transdermal patches again. The case suggested that clinical pharmacists should not always reject combination use of enzyme inhibitors and enzyme substrate, should weigh the advantages and disadvantages of these kinds of drug combination according to drug properties, dosage and safety.