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Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation
Hand-Foot syndrome (HFS) and diarrhoea are dose-limiting Adverse Drug Reactions (ADRs) of capecitabine-based chemotherapy. Four polymorphisms in the dihydropyrimidine dehydrogenase (DPYD) gene, encoding the DPD enzyme responsible for the metabolism of fluoropyrimidines, such as capecitabine, are str...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693983/ https://www.ncbi.nlm.nih.gov/pubmed/36355560 http://dx.doi.org/10.3390/ph15111388 |
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author | Stefanelli, Berenice Sellitto, Carmine De Bellis, Emanuela Torsiello, Martina Bertini, Nicola Pezzullo, Angelo Maria Corbi, Graziamaria Sabbatino, Francesco Pepe, Stefano Tesse, Angela Conti, Valeria Filippelli, Amelia |
author_facet | Stefanelli, Berenice Sellitto, Carmine De Bellis, Emanuela Torsiello, Martina Bertini, Nicola Pezzullo, Angelo Maria Corbi, Graziamaria Sabbatino, Francesco Pepe, Stefano Tesse, Angela Conti, Valeria Filippelli, Amelia |
author_sort | Stefanelli, Berenice |
collection | PubMed |
description | Hand-Foot syndrome (HFS) and diarrhoea are dose-limiting Adverse Drug Reactions (ADRs) of capecitabine-based chemotherapy. Four polymorphisms in the dihydropyrimidine dehydrogenase (DPYD) gene, encoding the DPD enzyme responsible for the metabolism of fluoropyrimidines, such as capecitabine, are strongly associated with severe ADRs, and their screening should be performed before starting treatment. Moreover, capecitabine-related toxicity may worsen due to drug-drug and drug-supplement interactions. Here we investigated factors responsible for severe HFS and diarrhoea presented by two patients, non-carriers of the recommended DPYD single nucleotide polymorphisms (SNPs) but carriers of other genetic variants suggested to increase the risk of capecitabine-related ADRs. Through careful therapy recognition, we demonstrated that, unbeknownst to the oncologists, the patients were taking folic acid during the treatment with capecitabine at a dosage higher than 2000 mg/m(2), which is the maximum tolerated dose when folate is administered. To resolve the ADRs, the therapy had to be drastically changed. In one case, dose reduction of capecitabine and discontinuation of lipid-lowering agents were carried out. In the other case, discontinuation of capecitabine and folic acid and capecitabine re-administration were performed after a month. Genetic and environmental factors should be considered good predictors of severe capecitabine-related toxicity. Medication reconciliation should be encouraged to avoid the harmful consequences of inappropriate treatments. |
format | Online Article Text |
id | pubmed-9693983 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96939832022-11-26 Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation Stefanelli, Berenice Sellitto, Carmine De Bellis, Emanuela Torsiello, Martina Bertini, Nicola Pezzullo, Angelo Maria Corbi, Graziamaria Sabbatino, Francesco Pepe, Stefano Tesse, Angela Conti, Valeria Filippelli, Amelia Pharmaceuticals (Basel) Case Report Hand-Foot syndrome (HFS) and diarrhoea are dose-limiting Adverse Drug Reactions (ADRs) of capecitabine-based chemotherapy. Four polymorphisms in the dihydropyrimidine dehydrogenase (DPYD) gene, encoding the DPD enzyme responsible for the metabolism of fluoropyrimidines, such as capecitabine, are strongly associated with severe ADRs, and their screening should be performed before starting treatment. Moreover, capecitabine-related toxicity may worsen due to drug-drug and drug-supplement interactions. Here we investigated factors responsible for severe HFS and diarrhoea presented by two patients, non-carriers of the recommended DPYD single nucleotide polymorphisms (SNPs) but carriers of other genetic variants suggested to increase the risk of capecitabine-related ADRs. Through careful therapy recognition, we demonstrated that, unbeknownst to the oncologists, the patients were taking folic acid during the treatment with capecitabine at a dosage higher than 2000 mg/m(2), which is the maximum tolerated dose when folate is administered. To resolve the ADRs, the therapy had to be drastically changed. In one case, dose reduction of capecitabine and discontinuation of lipid-lowering agents were carried out. In the other case, discontinuation of capecitabine and folic acid and capecitabine re-administration were performed after a month. Genetic and environmental factors should be considered good predictors of severe capecitabine-related toxicity. Medication reconciliation should be encouraged to avoid the harmful consequences of inappropriate treatments. MDPI 2022-11-10 /pmc/articles/PMC9693983/ /pubmed/36355560 http://dx.doi.org/10.3390/ph15111388 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Stefanelli, Berenice Sellitto, Carmine De Bellis, Emanuela Torsiello, Martina Bertini, Nicola Pezzullo, Angelo Maria Corbi, Graziamaria Sabbatino, Francesco Pepe, Stefano Tesse, Angela Conti, Valeria Filippelli, Amelia Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation |
title | Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation |
title_full | Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation |
title_fullStr | Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation |
title_full_unstemmed | Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation |
title_short | Concomitant Administration of Capecitabine and Folate Supplements: Need to Encourage Medication Reconciliation |
title_sort | concomitant administration of capecitabine and folate supplements: need to encourage medication reconciliation |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693983/ https://www.ncbi.nlm.nih.gov/pubmed/36355560 http://dx.doi.org/10.3390/ph15111388 |
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