门诊处方讨论TEMODAL课件.ppt

1、報告者:林婉薇指導藥師:林梅芳 學姊案例協助:靜卉,安儀 學姊特別感謝一起幫我留意處方的同事們目錄 門診處方案例 本院現有劑量劑型 作用 適應症 用法用量 最新健保規範 MICROMEDEX Healthcare Series 參考文獻門診處方案例 78歲,羅女士,就診科別:腦神經外科 出院診斷:Gliosarcoma(神經膠肉瘤)用藥:Acetaminophen 500mg/tab 1#QID 21days Haloperidol 5mg/tab 1#HS 21days Mgo 1#QID 21days Sennoside 2#HS 21days Temozolomide 100mg/cap

2、 1#QD 21days Valproic acid 500mg/tab 1#BID 21days其他案例比較 劉先生,就診科別:腦神經外科 診斷:顳葉惡性腫瘤 主要用藥:Temozolomide 100mg/cap 3#QD 5days Temozolomide 20mg/cap 1#QD 5days其他案例比較 吳女士,就診科別:腦神經外科 診斷:腦惡性腫瘤,放射線所致之影響 主要用藥:Temozolomide 100mg/cap 3#HS 5daysTEMODAL(Temozolomide)規格規格：20mg/cap 顏色顏色：白/黃色 劑型劑型：膠囊 形狀形狀：長圓柱形 標記標記：有T

3、EMODAL/20mg字樣 規格規格：100mg/cap 顏色顏色：白/粉紅色 劑型劑型：膠囊 形狀形狀：長圓柱形 標記標記：有TEMODAL/100mg字樣TEMODAL作用 具抗腫瘤活性,含有imidazotetrazine環的烷基化作用劑 它在全身循環中會在生理酸鹼值的狀態下,快速地透過化學轉化作用形成活性化合物MTIC(Monomethyl triazeno imidazole carboxamide)TEMODAL適應症 新診斷的多形神經膠母細胞瘤,與放射治療同步進行,然後作為輔助性治療 給予標準治療後復發性或惡化之惡性神經膠質瘤,例如多形神經膠母細胞瘤或退行性星狀細胞瘤TEMODA

4、L用法用量一.新診斷的多形神經膠母細胞瘤的成年病人同步治療期1.TEMODAL口服投與42天（75mg/體表面積 /day),與放射治療同步進行2.接著給予六個療程的輔助性TEMODAL3.42天同步治療期的TEMODAL劑量可持續至最長 49天條件條件：絕對嗜中性白血球計數15億個/L 血小板計數1000億個/L CTC非血液學毒性（禿髮,噁心,嘔吐除 外）第一級治療期間每週需測量一次全血球計數全血球計數輔助性治療期4.完成TEMODAL與放射治療同步治療之後四週,再給予六個療程的TEMODAL輔助性治療a.第一個（輔助性）療程的劑量是TEMODAL口服150mg/體表面積,每天1次,投與5

5、天,接著23天不用服藥b.開始第二個療程時,如果符合便可將治療劑量增加為200mg/體表面積如果劑量在第二個療程沒有增加,以後的療程就不應該增加劑量c.以後每個療程最初5天的劑量要保持在200mg/體表面積,除非毒性出現在治療期間,第22天（投與第1次TEMODAL 劑量的21天後）要測量全血球計數二.患有復發性或進行性神經膠質瘤的成人1.先前未曾接受過化療的病人先前未曾接受過化療的病人:每28天為一個療程,投與5天,每天1次,口服TEMODAL 200mg/體表面積2.先前接受過化療的病人先前接受過化療的病人:在第一個療程投與初始劑量TEMODAL 150mg/體表面積,在第二個療程的第一天

6、,如果絕對嗜中性白血球計數15億個/L,血小板計數1000億個/L,便可將治療劑量增加為200mg/體表面積三.患有復發性或進行性神經膠質瘤的兒童病人1.三歲或更大的兒童病人三歲或更大的兒童病人:每28天為一個療程,投與5天,每天1次,口服TEMODAL 200mg/體表面積2.先前接受過化療的兒童病人先前接受過化療的兒童病人:在第一個療程投與初始劑量150mg/體表面積,投與5天,如果沒有毒性,在第二個療程便可以將治療劑量增加為200mg/體表面積,投與5天可以持續使用至疾病進行治療期最長為2年全民健康保險藥品給付規定修正規定第9章 抗癌瘤藥物 Antineoplastics drugs（自

7、97年1月1日起實施）修正後給付規定 9.25.temozolomide(如Temodal)：（94/3/1、97/1/1）1.限用於經手術或放射線治療後復發之AA(anaplastic astrocytoma)或GBM(Glioblastoma multiforme)之病人。2.新診斷的多型性神經膠母細胞瘤，與放射線治療同步進行，然後作為輔助性治療。（97/1/1）3.需經事前審查核准後使用。備註：劃線部份為新修訂之規定。原給付規定 9.25.temozolomide(如Temodal)：(94/3/1)1.限用於經手術或放射線治療後復發之AA(anaplastic astrocytoma)

8、或GBM(Glioblastoma multiforme)之病人。2.需經事前審查核准後使用。TEMOZOLOMIDE Adult Dosing Anaplastic astrocytoma of brain,Refractory(following disease progression on nitrosourea and procarbazine):initial dose:150 mg/m(2)ORALLY every day for 5 days;cycle every 28 days;if the absolute neutrophil count and platelet cou

9、nt on day 29(day 1 of next cycle)and day 22 are equal to or greater than 1.5 x 10(9)/L and 100 x 10(9)/L respectively,increase dose to 200 mg/m(2)/day for 5 days Glioblastoma multiforme of brain,Newly diagnosed,concomitantly with radiotherapy and then as maintenance:concomitant to standard radiother

10、apy:initial dose,75 mg/m(2)ORALLY daily for 42 days;cycle every 28 days beginning 4 weeks after completion of initial therapy Glioblastoma multiforme of brain,Newly diagnosed,concomitantly with radiotherapy and then as maintenance:maintenance,cycle 1:150 mg/m(2)orally once daily for 5 days followed

11、by 23 days without treatment;cycles 2-6(each 28-days):200 mg/m(2)orally daily for the first 5 days of the cycle if common toxicity criteria(CTC)grade less than or equal to 2(except for alopecia,nausea and vomiting),absolute neutrophil count(ANC)greater than or equal to 1.5 x 10(9)/L,and the platelet

12、 count is greater than or equal to 100 x 10(9)/L;The dose remains at 200 mg/m(2)per day for the first 5 days of each subsequent cycle except if toxicity occurs;if the dose was not escalated at Cycle 2,escalation should not be done in subsequent cycles Metastatic melanoma,Monotherapy:200 mg/m(2)ORALL

13、Y daily for 5 consecutive days,every 28 days.Dose Adjustments hematologic,astrocytoma:(absolute neutrophil count(ANC)1,000/mcL or platelets 1,500/mcL and platelets 100,000/mcL;then reduce dose by 50 mg/m(2)/day for subsequent cycles,but not below 100 mg/m(2)hematologic,astrocytoma:(absolute neutroph

14、il count(ANC)1,000-1,500/mcL or platelets 50,000-100,000/mcL):hold therapy until ANC is greater than 1,500/mcL and platelets 100,000/mcL;maintain initial dose hematologic,astrocytoma:(absolute neutrophil count 1,500/mcL and platelets 100,000/mcL):increase or maintain dose at 200 mg/m(2)/day ORALLY f

15、or 5 days for subsequent cycles hematologic and non-hematologic(glioblastoma):concomitant phase;DISCONTINUE if absolute neutrophil count(ANC)is less than 0.5 x 10(9)/L,or the platelet count is less than 10 x 10(9)/L,or if a common toxicity criteria(CTC)grade 3 or 4 non-hematological toxicity(except

16、for alopecia,nausea,vomiting)occurs;INTERRUPT therapy if the ANC is at least 0.5 x 10(9)/L but less than 1.5 x 10(9)/L,or the platelet count is at least 10 x 10(9)/L but less than 100 x 10(9)/L,or if a CTC grade 2 non-hematological toxicity(except for alopecia,nausea,vomiting)occurs hematologic and

17、non-hematologic(glioblastoma):maintenance phase;REDUCE dose by 50 milligrams/square meter/day(mg/m(2)/day)if the absolute neutrophil count(ANC)is less than 1 x 10(9)/L,the platelet count is less than 50 x 10(9)/L,or if a common toxicity criteria(CTC)grade 3 non-hematological toxicity(except for alop

18、ecia,nausea,vomiting)occurs;DISCONTINUE therapy if a dose reduction to less than 100 mg/m(2)/day is required,a CTC grade 4 non-hematological toxicity(except for alopecia,nausea,vomiting)occurs,or if the same CTC grade 3 toxicity occurs after dose reduction 資料來源 義大藥劑科網站http:/www2.edah.org.tw/ph/index01.htm TEMODAL藥品仿單 MICROMEDEX Healthcare Series