Lenvatinib has clear medication restrictions in specific patients, and its safety is affected by liver function status and concomitant medication. Identifying taboo groups can effectively avoid serious adverse drug reactions.

1、 Severe liver injury patients

Patients with severe liver injury (Child Pugh C grade) are prohibited from using lenatinib.

The metabolic capacity of the liver in this population has significantly decreased, making it difficult to effectively remove drugs and their active metabolites, resulting in drug accumulation in the body and increasing the risk of liver toxicity.

For patients with moderate liver injury (Child Pugh B grade), it is necessary to adjust the starting dose under the guidance of a doctor and closely monitor liver function.

If there are signs of liver damage such as yellowing of the skin or sclera, dark urine, and pain in the upper right abdomen during medication, the medication should be stopped immediately and medical examination should be sought.

2、 The risk of combination therapy with potent CYP3A4 inducers

Lenvatinib is mainly cleared through CYP3A4 enzyme metabolism, and potent CYP3A4 inducers such as rifampicin, phenytoin, carbamazepine, and St. John's wort extract significantly accelerate its metabolism, leading to a significant decrease in blood drug concentration.

Reducing drug concentration can weaken anti-tumor efficacy and increase the risk of disease progression, so the combination of the two should be avoided.

If the above-mentioned drugs must be used in the treatment, consideration should be given to replacing them with alternative drugs that do not induce CYP3A4, or evaluating the possibility of interrupting lenatinib treatment.

In addition, the combination of lenatinib with potent CYP3A4 inhibitors such as ketoconazole and clarithromycin can increase drug exposure and should be treated with caution.

3、 Other groups to be aware of

Pregnant women: Animal studies have shown embryonic fetal toxicity, and women of childbearing age should take effective contraceptive measures during medication and for at least one month after discontinuation.

Breastfeeding women: It is recommended to pause breastfeeding during treatment and within one week after discontinuing medication to reduce the risk of infant exposure.