Pharmaceutical Care of Clinical Pharmacists for Anlotinib-induced ADR in 3 Patients with Advanced Lung Cancer / 中国药房

ABSTRACT

OBJECTIVE： To explore the role of clinical pharmacists on anlotinib-induced ADR in patients with advanced lung cancer， and to provide reference for safe drug use in clinic. METHODS： For 3 typical cases of ADR caused by the treatment of advanced lung cancer with anlotinib， clinical pharmacists provided pharmaceutical care to patients from the aspects of the use of anlotinib， medication education， the prevention and treatment of ADR， and assisted clinicians to solve ADR related to anlotinib such as hemoptysis， liver injury， elevated blood pressure， proteinuria， etc. RESULTS： For one case of anlotinib-induced hemoptysis， clinical pharmacists analyzed that the degree of hemoptysis was mild. They suggested that anlotinib should be discontinued and treated symptomatically with cough relief and hemostasis. If necessary， pituitrin should be added. Anlotinib could be continued after hemoptysis control， which doctors adopted. No hemoptysis occurred during the treatment period. For the case of anlotinib caused liver function damage， clinical pharmacists analyzed it as mild cholestasis type. They suggested that no discontinuation of anlotinib should be given and adenosylmethionine treatment should be given， which doctors adopted. After 5 days of treatment， the patients’ liver function returned to normal， and no obvious liver function damage was found in the later period. For the case of anlotinib induced hypertension with proteinuria， the patient had a history of hypertension. For hypertension， clinical pharmacists strengthened medication education for patients， instructed patients to adjust diet， appropriately activities， reduce mental stress and monitor blood pressure. The psychological intervention and other non-drug antihypertensive effects were poor， and then clinical pharmacists suggested to modify the antihypertensive treatment for patients. Doctors adopted it and changed the former antihypertensive drug nitrendipine to angiotensin receptor blocker valsartan. After 2 weeks of treatment， blood pressure returned to normal. For urinary protein， clinical pharmacists recommend to discontinue the use of anlotinib， and the urinary protein returned to normal after 2 weeks. Clinical pharmacists recommend to reduce the dose of anlotinib to continue treatment， which the doctors adopted. No abnormal urinary protein was found in the later review. CONCLUSIONS： Clinical pharmacists should actively provide pharmaceutical care for lung cancer patients treated with anlotinib， and strengthen medication education so as to promote rational drug use in clinic.