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題 名 | 口服低劑量Methotrexate引起之嚴重骨髓毒性=Low Dose Oral Methotrexate-induced Serious Myelotoxicity |
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作 者 | 王貞予; 吳建志; 陳文雯; 沈麗娟; 朱家瑜; 蕭斐元; 黃織芬; | 書刊名 | 臺灣醫學 |
卷 期 | 19:1 2015.01[民104.01] |
頁 次 | 頁83-90 |
分類號 | 418.29、418.29 |
關鍵詞 | 血液毒性; 骨髓抑制; 藥品不良反應; Methotrexate; Myelotoxicity; Bone marrow suppression; Adverse drug reaction; |
語 文 | 中文(Chinese) |
中文摘要 | Methotrexate(MTX)可用於抗腫瘤和調節風濕免疫疾病。過去認為低劑量使用時較不易出現不良反應;然而根據國內藥品不良反應通報系統的資料顯示,仍有許多口服低劑量MTX所造成的藥品不良反應,其中血液和淋巴系統異常佔所有通報案例的三分之一,又以全血球減少症(pancytopenia)的人數最多。由於此藥具有經濟、方便、有效性,在臨床上有無可取代的地位。因此本文整合相關案例和文獻,對於使用低劑量MTX時所需注意的臨床事項,提出以下建議:初次使用此藥時需進行嚴格的病人評估並搭配使用測試劑量(test dose:5-10mg),給藥後接近7天時需追蹤全血球數和肝腎功能,以偵測早發性之特異體質過敏反應。當病人腎功能不良或具有危險因子時,應使用較低的測試劑量(test dose:2.5mg-5mg)。用藥後需定期追蹤血球數、肝腎功能和相關不良反應,並給予病人充分用藥衛教,以降低毒性的發生率。 |
英文摘要 | Methotrexate is commonly used as a treatment for neoplasms and rheumatologic disorders. Low-dose oral usage was considered to be associated with lower risks of adverse events. Nevertheless, statistics from the Taiwan National Adverse Drug Reaction Reporting System report that MTX- related adverse effects (especially myelotoxicity) is increasing and deems that it's a critical issue to deal with. This review thus focuses on precautions in use of low-dose MTX in clinical settings. Based on our review, for first-time users, it is suggested that MTX to be initiated at a test dose between 5-10mg. Monitoring of laboratory tests at one week of initiating therapy, including complete blood count, liver function and renal function, are also recommended for first-time MTX users to detect early onset of idiosyncratic toxicity. For patients with impaired renal function or other risk factors for myelotoxicity, a test dose between 2.5-5mg is recommended. Regular monitoring of laboratory tests and related side effects as well as patient education are also recommended to minimize the risk of MTX-induced toxicity. |
本系統中英文摘要資訊取自各篇刊載內容。