甲磺酸阿帕替尼致严重手足皮肤反应的药学监护及文献复习

Pharmaceutical care of a patient with severe hand-foot skin reactions induced by apatinib mesylate and literature review

目的:探讨针对甲磺酸阿帕替尼片致手足皮肤反应的药学监护方法,为临床合理用药提供参考。方法:报道1例应用甲磺酸阿帕替尼片治疗晚期胃癌诱发严重手足皮肤反应的患者,结合文献对其临床表现、处理原则及其可能的发生机制进行综述。结果:口服甲磺酸阿帕替尼片诱发或加重手足皮肤反应多发生在服药后2~3周,临床表现多为掌跖部位、手指、关节、脚趾红斑、肿胀、疼痛,皮肤角化过度,伴有感觉异常。甲磺酸阿帕替尼片相关手足皮肤反应的发生与血管内皮生长因子被抑制、毛细血管修复能力下降等因素有关。可通过生活护理、调整甲磺酸阿帕替尼片剂量、外用含有尿素的润肤剂、使用镇痛药、外用超强效皮质类固醇类药物等,减轻手足皮肤反应的严重程度。如果手足皮肤反应反复发作且较难控制,可考虑更换其他靶向药物。结论:在合理应用甲磺酸阿帕替尼片过程中,手足皮肤反应的发生并不少见。临床医师和临床药师均应加强用药监测,以减少药品不良反应的发生。一旦出现手足皮肤反应,需及时对症处理并密切观察,以提高药物治疗的安全性和有效性。

Objective:To explore pharmaceutical care methods for hand-foot skin reactions induced by apatinib mesylate tablets,so as to provide reference for rational use of drugs clinically.Methods:A case of severe hand-foot skin reactions induced by apatinib mesylate tablets in the treatment of advanced gastric cancer was reported.The clinical manifestations,treatment principles and possible mechanism of the disease were reviewed in combination with literature.Results:Most of the hand-foot skin reactions caused by oral administration of apatinib mesylate tablets occurred 2-3 weeks after medication,mostly with clinical manifestations of erythema in palms,fingers,joints and toes accompanied with swelling and pain,as well as hyperkeratosis of the skin with paresthesia.The occurrence of hand-foot skin reactions caused by apatinib mesylate tablets were associated with such factors as inhibition of vascular endothelial growth factor and decreased capillary repair capacity and other factors.To prevent its occurrence,daily life care,adjustment of the dosage of apatinib mesylate,external application of topical emollients containing urea,analgesics and external use of super-potent topical corticosteroids could obviously reduce the severity of hand-foot skin reactions.If hand-foot skin reactions were recurrent and difficult to control,replacement with other targeted drugs could be considered.Conclusion:In the application of apatinib mesylate tablets,hand-foot skin reactions were not rare.Close attention should be paid to drug monitoring on the part of clinicians and clinical pharmacists,so that the occurrence of adverse drug reactions could be reduced.In case there were hand-foot skin reactions,timely symptomatic treatment and close observation should be given,so as to improve the safety and efficacy of drug therapy.