The use of Pacritinib should focus on three major types of adverse reactions: bleeding risk, cardiac toxicity, and gastrointestinal reactions, and graded management measures should be taken according to the severity of symptoms. The following provides a detailed explanation of precautions in terms of monitoring requirements, intervention measures, and dosage adjustments.

1. Bleeding risk management

(1) Absolute contraindication: Patients with active bleeding or platelet count<50 × 10 ⁹/L are prohibited from using medication, and medication should be suspended before and after surgery.

(2) Monitoring requirements: During the treatment period, platelet count should be checked weekly. If bleeding symptoms such as bruising and nosebleeds occur, seek medical attention immediately.

(3) Intervention measures: Treatment should be interrupted for bleeding of grade 2 or above, and platelet transfusion or fresh frozen plasma should be administered if necessary.

Prevention and control of cardiac toxicity

(1) Taboo population: Patients with severe heart block and uncontrolled arrhythmia are prohibited from using it.

(2) Monitoring requirements: Baseline and monthly follow-up electrocardiograms should be conducted to monitor changes in QT interval (>500ms should be discontinued).

(3) Electrolyte management: Maintain blood potassium levels above 4mEq/L and blood magnesium levels above 1.8mg/dL, and avoid the use of QT prolonging drugs in combination.

3. Treatment of gastrointestinal reactions

(1) Diarrhea management: Loperamide should be used for grades 1-2, and for grade 3, administration should be suspended and intravenous fluid replacement should be administered.

(2) Nausea control: Ondansetron is preferred, and dexamethasone can be used in combination for stubborn symptoms.

(3) Perforation risk: If there is abdominal pain or fever, intestinal perforation should be investigated, and medication should be permanently discontinued after diagnosis.

4 Other important matters

(1) Drug interactions: Avoid using potent CYP3A4 inhibitors in combination and reduce dosage by 50% if necessary.

(2) Special population: Prohibited during pregnancy, breastfeeding is prohibited within 7 days after discontinuation of medication.

(3) Liver function monitoring: Patients with moderate to severe injuries need to reduce their dosage and undergo monthly ALT/AST testing.