Special attention should be paid to serious adverse reactions such as liver toxicity and infection risk when using idelalisib. At the same time, it is necessary to standardize the handling of missed doses and pay attention to medication contraindications for special populations. The following is a detailed explanation of specific medication precautions.

1. Monitoring of serious adverse reactions

Throughout the treatment process, liver function needs to be monitored, with ALT/AST testing conducted weekly in the initial stage and monthly testing after 3 months. If ALT/AST>5 × ULN, administration should be suspended; if ALT/AST>20 × ULN, administration should be permanently discontinued.

When diarrhea occurs, the severity should be evaluated. If the diarrhea is ≥ grade 3, treatment should be interrupted and corticosteroids should be used. If the condition persists, medication should be discontinued.

During treatment, if pulmonary symptoms such as coughing and difficulty breathing occur, medication should be stopped immediately and checked. If pneumonia is diagnosed, medication should be permanently stopped.

2. Omission and Overtreatment

If the missed dose is more than 6 hours away from the next dose, it can be supplemented, and if it is less than or equal to 6 hours, it will be skipped. Take only once a day and do not double the dosage.

If there is suspicion of overdose, immediate medical attention should be sought, which may require gastric lavage or symptomatic supportive treatment. There is no specific antidote.

3. Infection prevention measures

Before treatment, existing infections need to be controlled and PJP prevention should be carried out throughout the entire process. If symptoms of infection such as fever occur, seek medical attention immediately.

CMV seropositive patients need to be regularly monitored for viral load, and treatment should be interrupted until viremia is cleared.

4. Medication for special populations

Pregnant women are prohibited from using contraception, and women of childbearing age need to use contraception for one month after discontinuing the medication. Suspend breastfeeding during treatment for lactating women.

Elderly patients are more prone to serious adverse reactions, and it is necessary to strengthen monitoring and adjust dosage according to tolerance.

5. Other important precautions

Avoid co administration of hepatotoxic drugs. During treatment, avoid receiving live vaccines and strengthen protection when in contact with infected patients.

Severe skin reactions such as skin blisters and mucosal erosion require permanent discontinuation of medication and emergency treatment.