氟康唑加重普拉替尼血液毒性的病例分析

Case analysis of fluconazole aggravating blood toxicity of pralsetinib

1例61岁晚期肺癌女性患者在同时接受普拉替尼与氟康唑治疗4 d后,出现了4级中性粒细胞减少及2级血小板减少。临床药师考虑为氟康唑与普拉替尼相互作用引起的血液毒性,依次停用普拉替尼和氟康唑,给予患者重组人粒细胞刺激因子升白细胞治疗,待血细胞计数恢复后,予普拉替尼剂量减半重启治疗,并逐渐恢复至原治疗剂量,后续治疗未再出现不良反应。此病例提示医生及临床药师应意识到普拉替尼与氟康唑有潜在的相互作用,并在普拉替尼治疗期间避免使用CYP3A4抑制药且注意调整药物剂量。

This paper analyzed a 61-year-old female patient with advanced lung cancer with grade 4 neutropenia and grade 2 thrombocytopenia after 4 days of concurrent treatment with pralsetinib and fluconazole.Clinical pharmacists considered it to be caused by fluconazole aggravating pralsetinib hematologic toxicity,successively stopped pralsetinib and fluconazole,gave patients recombinant human granulocyte stimulation factor to rise the white blood cell.After the blood cell count returned to normal,the treatment by halving the dosage of pralsetinib restarted and it gradually returned to the original dose,and no adverse reactions occurred in the subsequent treatment.This case suggests that physicians and clinical pharmacists should be aware of the potential interaction between pralsetinib and fluconazole,avoid the use of Cytochrome P4503A4(CYP3A4)inhibitors and adjust the dosage of drugs during pralsetinib treatment.