1例小剂量瑞戈非尼致晚期软组织肉瘤患者精神异常的药学监护

A case of pharmaceutical caring for psychiatric abnormalities associated with low dose regorafenib in the treatment of advanced soft tissue sarcoma

临床药师参与1例非脂肪软组织肉瘤患者使用小剂量瑞戈非尼致精神异常的临床实践。该患者合并低蛋白血症、肝功能不全、脑白质病等多种疾病,治疗前精神正常,使用瑞戈非尼40 mg,po,qd,用药5 d后突发意识不清。临床药师通过分析排除了肿瘤脑转移、脑白质病变加重或肝性脑病等疾病及合并用药引起精神异常的可能,评定患者精神异常与瑞戈非尼的关联性为“很可能”,考虑精神异常为瑞戈非尼所致不良反应,立即停药,同时给予对症处理,5 d后患者精神状态好转。此外,临床药师监护患者治疗,并结合循证证据提供合适的抗肿瘤药物治疗建议。该病例提示临床使用瑞戈非尼时应警惕精神异常不良反应,做好药学监护,发生不良反应后及时进行用药分析和对症处理。

In this report,we described a case of a clinical practice,in which the clinical pharmacists was involved in the treatment of a soft tissue sarcoma patient,who was diagnosed with mental disorders induced by regorafenib.The patient was complicated with hypoproteinemia,hepatic insufficiency,leukoencephalopathy and other diseases.Before the treatment,the patient's mental was normal.After continuous administration of regorafenib(40 mg,po,qd) for 5 days,the patient has a sudden loss of consciousness.Clinical pharmacists excluded the possibility of mental disorders caused by tumor brain metastases,exacerbation of leucoencephalopathy or hepatic encephalopathy and the drugs used together.They determined that mental disorders were likely to be related to the use of regorafenib through the association evaluation of adverse reactions.It was considered to be an adverse reaction induced by regorafenib.Therefore,regorafenib treatment was temporarily suspended and symptomatic treatment was given.A?ter 5 days,the patient's mental state improved.In addition,clinical pharmacists monitored the patient for symptomatic treatment,and provided appropriate antitumor drug treatment recommendations based on evidence-based evidence.This case suggests that the clinical use of regorafenib should be vigilant against mental disorders adverse reactions,do a good job of pharmaceutical care,and timely drug analysis and symptomatic treatment a?ter adverse reactions.