奈妥匹坦帕洛诺司琼胶囊致5-羟色胺综合征病例分析★

Analysis of serotonin syndrome caused by netupitant and palonosetron capsules★

摘要:

通过分析3例行ddEC-T方案化疗的激素受体阳性乳腺癌患者使用奈妥匹坦帕洛诺司琼胶囊后出现5-羟色胺综合征（SS）的病例，结合文献学习、临床特点和诊治过程进行关联性分析，探讨其发生机制及处理方法，旨在为临床安全用药提供参考依据。3例患者均在化疗前1 h口服奈妥匹坦帕洛诺司琼胶囊进行止吐预处理，且均在化疗后24 h内出现SS，临床表现主要包括自主神经过度活跃（如头晕、发热、恶心、冷汗淋漓、上腹部不适、心慌等）、神经肌肉异常（如四肢麻木、右上肢震颤、小便失禁等）及精神状态改变（如情绪焦躁、烦闷等）。患者接受卧床休息、持续吸氧、心电监护、静脉补钾、补液、止吐等对症治疗，必要时口服地西泮片镇静，症状得以缓解。根据Naranjo不良反应因果关系评估量表，3例患者发生SS与奈妥匹坦帕洛诺司琼胶囊的关联性评分为7分，评价为“很可能有关”。临床药师分析认为，SS的发生可能与奈妥匹坦帕洛诺司琼与环磷酰胺、西咪替丁的相互作用有关，或者可能是由于奈妥匹坦帕洛诺司琼胶囊剂量增加所致，建议后续治疗中更换为阿瑞匹坦。SS的预防至关重要，临床实践中应尽量避免药物间相互作用的发生。在药物选择上，可根据患者病情酌情选用其他替代药物；若必须联合使用相关药物，则需严密监测患者的临床表现和相关指标，以确保用药安全。

Abstract:

To assist clinicians and pharmacists in understanding the mechanism and management of serotonin syndrome induced by netupitant and palonosetron (NEPA) capsules, clinical pharmacists analyzed three cases of hormone receptor-positive breast cancer patients undergoing ddEC-T chemotherapy who developed serotonin syndrome after using NEPA capsules. The analysis was conducted by reviewing the clinical characteristics, diagnosis, and treatment processes, combined with a literature review, to provide insights for safe clinical medication practices. All three patients were administered NEPA capsules one hour before chemotherapy as antiemetic prophylaxis and developed serotonin syndrome within 24 hours post-chemotherapy. Symptoms included autonomic hyperactivity (such as dizziness, fever, nausea, sweating, epigastric discomfort, palpitation, etc.), neuromuscular abnormalities (such as limb numbness, tremors in the right upper limb, urinary incontinence, etc.) and mental state changes (such as emotional anxiety, distress, etc.). The patient received symptomatic treatment including bed rest, continuous oxygen therapy, cardiac monitoring, intravenous rehydration with potassium supplementation, antiemetics, and oral diazepam for sedation when necessary, and the symptoms were alleviated. Using the Naranjo adverse drug reaction probability scale, the association between serotonin syndrome and the suspected drug, NEPA capsules, was evaluated with a score of 7, indicating a probable relationship. Clinical pharmacists suggested that serotonin syndrome might be related to drug interactions between NEPA and chemotherapy agents such as cyclophosphamide or adjuvant drugs like cimetidine, or possibly due to increased dosage of NEPA. It was recommended to consider alternative NK-1 receptor antagonists (aprepitant) for subsequent treatments. Prevention is crucial in managing serotonin syndrome, and clinicians should avoid potential drug-drug interactions. Alternative therapeutic agents should be considered based on the patient's condition, and close monitoring is essential when combination therapy is unavoidable.