埃克替尼致携带乙肝病毒的肺癌患者肝损伤的药学监护

Pharmaceutical Care for Icotinib-induced Liver Damage in Patient with Hepatitis B Virus

目的:探讨临床药师对埃克替尼致携带乙肝病毒的肺癌患者肝损伤的药学监护模式及作用。方法:临床药师参与1例埃克替尼致携带乙肝病毒的肺癌患者肝损伤的药学监护,分析肝损伤的原因,建议暂停盐酸埃克替尼片;增加保肝治疗方案双环醇片25 mg,po,tid+葡醛酸钠注射液0.266 g,ivgtt,qd+多烯磷脂酰胆碱注射液10 ml,ivgtt,qd;避免增加还原型谷胱甘肽致保肝药物过多增加肝脏负担;肝功能正常后停用葡醛酸钠注射液和多烯磷脂酰胆碱注射液,恢复原埃克替尼治疗方案125 mg,po,tid;病情进展后停用盐酸埃克替尼片,维持给予双环醇片6个月。结果:医师采纳临床药师建议,采用上述治疗36 d后,患者停用埃克替尼,第42天,肝功能指标示正常。结论:临床药师参与药物治疗进行个体化的用药指导,保证了药物的安全、合理和有效应用。

OBJECTIVE：To explore the mode and role of clinical pharmacists providing pharmaceutical care for icotinib-induced liver damage in patient with hepatitis B virus. METHODS：Clinical pharmacists participated in pharmaceutical care for icotinib-induced liver damage in a patient with hepatitis B virus,analyzed the cause of liver damage and suggested to stop taking Icotinib hydrochloride tablet;Bicyclol tablet 25 mg,po,tid＋Sodium glucuronate injection 0.266 g,ivgtt,qd＋Polyene phosphatidylcholine injection 10 ml,ivgtt,qd for protecting liver;avoid the increase of liver burden induced by reduced glutathione;stopped taking Sodium glucuronate injection and Polyene phosphatidylcholine injection and continued to take icotinib 125 mg,po,tid after liver function recovered;stopped taking Icotinib hydrochloride tablet and continued to take Bicyclol tablet for 6 months after progression disease. RESULTS：Physician adopted the suggestions of clinical pharmacists,adopted above treatment plan for 36 d,the patient stopped taking Icotinib hydrochloride tablet and liver function index recovered to normal after 42 days. CONCLUSIONS：Clinical pharmacists provide individualized medication guideline and guarantee the safe,rational and effective use of drugs.