伊马替尼和华法林合用引发血尿1例

Hematuria caused by combination of imatinib and warfarin:a case report

目的:结合具体病例回顾酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKIs)与华法林相互作用的研究现状。方法:1例女性在合用伊马替尼和华法林半年后出现血尿,药师分析不良反应的原因并提出处理方式。结果:血尿的产生可能是伊马替尼和华法林的相互作用引起两者血中浓度升高,药效均增强的结果。药师建议立即降低华法林剂量至1.5 mg qd,5 d后复查国际标准化比值(international normalized ratio,INR)降为1.85。结论:华法林与TKIs合用应每周仔细监测INR,及时调整华法林的剂量。对于有相互作用风险的药物,伊马替尼血药浓度监测应贯穿于治疗的全程。

Objective:To review the interaction between tyrosine kinase inhibitors(TKIs)and warfarin combining a specific case.Methods:A female patient developed hematuria after half a year of combination of imatinib with warfarin.The pharmacist analyzed the causes of adverse reactions and proposed the treatment methods.Results:Hematuria was probably caused by the interaction between imatinib and warfarin,which resulted in the increase of their blood concentrations and drug efficacy of imatinib and warfarin.The pharmacist suggested that the warfarin dose should be reduced to 1.5 mg qd immediately,and the international normalized ratio(INR)decreased to 1.85 after 5 days.Conclusion:INR should be carefully monitored every week when the combination of Warfarin with TKIs,and it is suggested that the dose of warfarin should be adjusted in time.For the drugs with interaction risk,the monitoring of imatinib plasma concentration should run through the whole course of treatment.