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The recommended starting dose of imatinib mesylate for patients in the blast phase and accelerated phase of chronic myelogenous leukemia is /day. For patients in the chronic phase who have failed interferon therapy, as well as patients with malignant gastrointestinal tumors that cannot be surgically resected or metastasized. For patients with tumors, the recommended dose is 1/day, which should be taken orally once a day. It is advisable to take the medicine with meals and drink a large glass of water. As long as it is effective, it should be continued.
If the blood picture permits and there are no serious adverse drug reactions, the dose may be considered to be increased from / day to / day, or from / day to / day (taken in divided doses) under the following circumstances: disease progression and treatment for at least one month Afterwards, satisfactory hematological response could not be obtained, and the hematological response that had been achieved disappeared again.
The dose must be adjusted in the following situations. If serious non-hematological adverse reactions (such as severe water retention) occur during treatment, the drug should be discontinued until the adverse reactions disappear, and then the dose will be adjusted according to the severity of the adverse reactions.
When adjusting the dose when severe liver toxicity occurs, such as when the increase in bilirubin exceeds the upper limit of the normal range or the increase in transaminases exceeds the upper limit of the normal range, the drug should be discontinued until the above indicators drop to the upper limit of the normal range respectively. Or. times or less.
Dose adjustment during neutropenia or thrombocytopenia during accelerated phase or blast phase If severe neutropenia and thrombocytopenia occur (neutrophils less than ./and/or platelets less than . .If the blood cells continue to decrease for weeks, the dose should be further reduced to /day. If the blood cells continue to decrease for weeks, it is advisable to stop the drug until neutrophils and platelets continue to decrease. The dose is /day when used again.
Interferon treatment After failure, patients in the chronic phase should stop taking the drug when their neutrophils are less than ./ and/or platelets are less than /, and then resume medication only when their neutrophils are less than ./ and platelets/, the dose is /day, such as neutrophils or platelets When the dose is reduced to the above values again, the dose is reduced to /day when the drug is resumed.
Dosage in patients with hepatic failure The plasma concentration of imatinib mesylate in patients with hepatic impairment can increase, so these patients should use Caution should be exercised when using this drug. There are no clinical data on the use of imatinib mesylate in patients with hepatic impairment, and no recommendations for dosage adjustment can be made.
The dosage for patients with renal failure and elderly patients is known to vary with creatinine clearance. It decreases with aging, but age has no significant effect on the pharmacokinetics of imatinib mesylate. Since no clinical trials have been conducted in patients with renal impairment, no dosage adjustment recommendations can be made.