1例吉非替尼与华法林相互作用的案例报道及文献分析
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摘要
目的结合实际案例,对吉非替尼与华法林联用时华法林的剂量调整进行文献检索和分析,为给药方案的优化提供参考。方法报道1例病例,同时查阅国内外相关文献并进行综述分析。结果本例患者在合并使用吉非替尼26 d后,INR值明显升高(5.23),停药后调整华法林剂量,将INR值控制在目标范围内。文献综述分析提示,吉非替尼及表皮生长因子受体酪氨酸激酶抑制剂与华法林联用时,有一部分人群可能会出现INR值升高,出血风险增加。结论华法林和表皮生长因子受体酪氨酸激酶抑制剂联合使用时,建议在启用以及停药后,增加INR的监测频率,及时调整华法林剂量。
OBJECTIVE To report an actual case and review about the interaction of warfarin and gefitinib to provide a regimen about the combination of the two drugs. METHODS Discribed a case and analyzed it,while access to relevant literature review. RESULTS With concomitant administration of gefitinib and warfarin, 26 d later the patient's INR values increased to 5.23, then discontinue the two drugs, the patient's warfarin dosage was adjusted to reach the target INR values when reused the two drugs. According to the literature analysis, when combination between gefitinib or epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKI) with warfarin, some patients' INR values increased, and also the risks of bleeding.CONCLUSION Concomitant administration of EGFR-TKI and warfarin, closer INR monitoring ang dose adjustments of warfarin may be necessary when EGFR-TKI initiated and discontinued.
OBJECTIVE To report an actual case and review about the interaction of warfarin and gefitinib to provide a regimen about the combination of the two drugs. METHODS Discribed a case and analyzed it,while access to relevant literature review. RESULTS With concomitant administration of gefitinib and warfarin, 26 d later the patient's INR values increased to 5.23, then discontinue the two drugs, the patient's warfarin dosage was adjusted to reach the target INR values when reused the two drugs. According to the literature analysis, when combination between gefitinib or epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKI) with warfarin, some patients' INR values increased, and also the risks of bleeding.CONCLUSION Concomitant administration of EGFR-TKI and warfarin, closer INR monitoring ang dose adjustments of warfarin may be necessary when EGFR-TKI initiated and discontinued.
引文
[1]DAVID S,ETTINGER,DOUGLAS,et al.Non-small cell lung cancer(version 6)[S].NCCN Clinical Practice Guidelines in Oncology,2018:8.
[2]ZHAO J,CHEN J Y,TANG J C,et al.Research progress on the mechanism of gefitinib resistance and treatment in non-small cell lung cancer[J].Chin J Mod Appl Pharm(中国现代应用药学),2017,34(6):923-927.
[3]MILLER G P.Warfarin therapy:how the less interesting half just got interesting[J].J Thromb Haemost,2010(8):2705-2707.
[4]武云花,李丽华,寿涛,等.吉非替尼治疗合并肺栓塞的肺腺癌患者1例[J].临床肺科杂志,2013,18(12):2324-2325.
[5]GUO L,HOU J,LIU Y,et al.Drug interaction induced by incotinib and warfarin in one patient[J].Chin J New Drugs Clin Rem(中国新药与临床杂志),2014,33(7):551-552.
[6]ONODA S,MITSUFUJI H,YANASE N,et al.Drug interaction between gefitinib and warfarin[J].Jpn J Clin Oncol,2005,35(8):478-482.
[7]THOMAS K S,BILLINGSLEY A,AMARSHI N,et al.Elevated international normalized ratio associated with concomitant warfarin and erlotinib[J].Am J Health Syst Pharm,2010,67(17):1426-1429.
[8]ARAI S,MITSUFUJI H,NISHII Y,et al.Effect of gefitinib on warfarin antithrombotic activity[J].Int J Clin Oncol,2009,14(4):332-336.
[9]FANG S J,LIN W W,LIN R F,et al.Relationship of VKORC1-3673G>A,CYP2C9*3,CYP4F2 rs2108622 and CYP2C19*2 genetic polymorphisms and maintenance warfarin dose requirement in Han-Chinese patients with atrial fibrillation[J].Chin J Mod Appl Pharm(中国现代应用药学),2018,35(9):1379-1384.
[10]PRIMEAUX B,BURTON B,SHUEY S.Supratherapeutic INR resulting from the initiation of warfarin in a patient receiving axitinib[J].J Oncol Pharm Pract,2018,24(1):74-75.
[11]KUBOMURA Y,LSE Y,WAKO T,et al.A drug interaction between crizotinib and warfarin in non-small-cell lung cancer:a case report[J].J Nippon Med Sch,2017,84(6):291-293.
[2]ZHAO J,CHEN J Y,TANG J C,et al.Research progress on the mechanism of gefitinib resistance and treatment in non-small cell lung cancer[J].Chin J Mod Appl Pharm(中国现代应用药学),2017,34(6):923-927.
[3]MILLER G P.Warfarin therapy:how the less interesting half just got interesting[J].J Thromb Haemost,2010(8):2705-2707.
[4]武云花,李丽华,寿涛,等.吉非替尼治疗合并肺栓塞的肺腺癌患者1例[J].临床肺科杂志,2013,18(12):2324-2325.
[5]GUO L,HOU J,LIU Y,et al.Drug interaction induced by incotinib and warfarin in one patient[J].Chin J New Drugs Clin Rem(中国新药与临床杂志),2014,33(7):551-552.
[6]ONODA S,MITSUFUJI H,YANASE N,et al.Drug interaction between gefitinib and warfarin[J].Jpn J Clin Oncol,2005,35(8):478-482.
[7]THOMAS K S,BILLINGSLEY A,AMARSHI N,et al.Elevated international normalized ratio associated with concomitant warfarin and erlotinib[J].Am J Health Syst Pharm,2010,67(17):1426-1429.
[8]ARAI S,MITSUFUJI H,NISHII Y,et al.Effect of gefitinib on warfarin antithrombotic activity[J].Int J Clin Oncol,2009,14(4):332-336.
[9]FANG S J,LIN W W,LIN R F,et al.Relationship of VKORC1-3673G>A,CYP2C9*3,CYP4F2 rs2108622 and CYP2C19*2 genetic polymorphisms and maintenance warfarin dose requirement in Han-Chinese patients with atrial fibrillation[J].Chin J Mod Appl Pharm(中国现代应用药学),2018,35(9):1379-1384.
[10]PRIMEAUX B,BURTON B,SHUEY S.Supratherapeutic INR resulting from the initiation of warfarin in a patient receiving axitinib[J].J Oncol Pharm Pract,2018,24(1):74-75.
[11]KUBOMURA Y,LSE Y,WAKO T,et al.A drug interaction between crizotinib and warfarin in non-small-cell lung cancer:a case report[J].J Nippon Med Sch,2017,84(6):291-293.