nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2018-22-1-104-113nefr-339Research ArticleПРОГРАММА НЕПРЕРЫВНОГО ПОСЛЕДИПЛОМНОГО ОБРАЗОВАНИЯ ПО НЕФРОЛОГИИPROGRAM ON CONTINUOUS POSTGRADUATE EDUCATION ON NEPHROLOGYПРИМЕНЕНИЕ ЦИКЛОФОСФАМИДА В РУТИННОЙ ПРАКТИКЕ ПРИ ЛЕЧЕНИИ АУТОИММУННЫХ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЙ: ОБЗОРCYCLOPHOSPHAMIDE ADMINISTRATION ROUTINE IN AUTOIMMUNE RHEUMATIC DISEASES: A REVIEWТелесК. А.TelesK. A.

Кайан Аморим Телес - медицинский факультет, DF, 70910-900, Бразилиа

Kaian Amorim Teles - Departamento de Ciências da Saúde, DF, 70910-900, Brasília

kaian.teles@gmail.comМедейрос-СоузаП.Medeiros-SouzaP.

Патрисиа Медейрос-Соуза – медицинский факультет, DF, 70910-900.

Бразилиа, Кампинас

Patricia Medeiros-Souza - Departamento de Ciências da Saúde, DF, 70910-900, Brasília

pmedeirossouza@uol.com.brЛимаФ.А. К.LimaF. A. C.

Франциско Айрес Корреа Лима - DF, 70840-901, Клиника ревматологии, Отделение коллагенозов, Бразилиа

 

Francisco Aires Correa Lima - DF, 70840-901, Servic¸o de Reumatologia, Ambulatório de Colagenoses, Brasília

де АраужуБ. Г.De AraújoB. G.

Бруно Гедеон де Араужу – 604/605, AsaNorte, DF, 70840-901, Бразилиа

 

Bruno Gedeon de Araújo – DF,604/605, Asa Norte, 70840-901, Brasília

ЛимаР.А. К.LimaR.A. C.

Родриго Айрес Корреа Лима - отделение ревматоидного артрита БФО

Университет г. Бразилиа (UnB)БразилияUniversidade de Brasília (UnB)BrazilУниверситет г. Бразилиа (UnB); Государственный университет г. Кампинаса (Unicamp)БразилияUniversidade de Brasília (UnB); Universidade Estadual de Campinas (Unicamp)BrazilУниверситет г. Бразилиа (UnB), Университетская клиника г. БразилиаБразилияUniversidade de Brasília (UnB), Hospital Universitário de BrasíliaBrazilУниверситетская клиника г. Бразилиа (HuB)БразилияHospital Universitário de Brasília (HuB)BrazilУниверситет г. Бразилиа (UnB), Университетская клиника г. Бразилиа, Клиника ревматологии; Больница Федерального округа, Клиника ревматологииБразилияUniversidade de Brasília (UnB), Hospital Universitário de Brasília; Hospital de Base do Distrito Federal, Servic¸o de ReumatologiaBrazil201829012018221104113Copyright © Телес К.А., Медейрос-Соуза П., Лима Ф.К., де Араужу Б.Г., Лима Р.К., 20182018Телес К.А., Медейрос-Соуза П., Лима Ф.К., де Араужу Б.Г., Лима Р.К.Teles K.A., Medeiros-Souza P., Lima F.C., de Araújo B.G., Lima R.C.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/339

Циклофосфамид (ЦФ) – алкилирующий агент, широко используемый для лечения как злокачественных новообразований, так и для терапии множества ревматических болезней. Ошибки при применении этого препарата могут привести к снижению его эффективности или увеличению лекарственной токсичности. Целью  настоящего исследования было структурировать режим применения ЦФ, а также  разработать фармакотерапевтическое пособие для  пациентов. Режим применения ЦФ можно разделить на три этапа: до химиотерапии, введение ЦФ, после химиотерапии, что учитывает лекарственные препараты, назначаемые до и после введения ЦФ с целью предупреждения побочных эффектов, включая тошноту  и геморрагический цистит. Побочные эффекты могут  проявиться в лабораторных тестах: так,  применение препарата требует клинического наблюдения за уровнями лейкоцитов, тромбоцитов, нейтрофилов и натрия, а также  коррекции дозы ЦФ при заболевании почек. ЦФ может быть причиной других редких, но серьезных побочных эффектов, например, гепатотоксичности, тяжелой гипонатриемии, сердечной недостаточности. Другие побочные реакции  включают потерю волос, аменорею  и менопаузу. В режим применения ЦФ мы также  внесли рекомендации для пациентов после химиотерапии. Описана совместимость инъекционной формы с растворителем, как и стабильность лекарственного вещества и время введения. Целью  предложенного режима являются рациональное использование ЦФ и предотвращение побочных эффектов  и рецидивов заболевания – факторов,  снижающих клиническую эффективность.

Cyclophosphamide is an alkylating  agent widely used for the  treatment of malignant neoplasia and  which can  be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead  to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized  in three phases: pre-chemotherapy, administration of cyclophosphamide, and  post-chemotherapy, taking  into account the  drugs to be  administered before and  after  cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and  sodium, including cyclophosphamide dose adjustment in the  case of kidney disease. Cyclophosphamide is responsible for other rare – but serious – side  effects, for instance, hepatotoxicity, severe hyponatremia and  heart failure. Other  adverse reactions include hair loss, amenorrhea and  menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the  vehicle  used has  been described, as well as stability  and  infusion  times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and  relapse episodes, factors that may burden the health care system.

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The authors declare that there are no conflicts of interest present.