Tirabrutinib is an oral BTK inhibitor, and rash, diarrhea, and bruising are relatively common during treatment. Most are mild to moderate, and early recognition and standardized management can avoid treatment interruption. The key management points are described below.

I. Rash

Early recognition: It mostly appears in the early stage of medication, manifesting as erythema, papules, or pruritus, commonly on the face, neck, and trunk.

Daily care: Keep the skin clean and dry, use mild moisturizers, avoid washing with hot water and scratching, and wear loose cotton clothing.

Sun protection and light avoidance: Take good sun protection when going out to reduce sun exposure-induced or aggravated rash.

Seek medical attention promptly: Immediately seek medical care when widespread rash, blisters, mucosal involvement, or fever occurs, and be alert to severe skin reactions.

Medication management: For mild cases, topical corticosteroids or oral antihistamines may be used according to the physician's instructions; for severe cases, medication should be suspended and whether to reduce the dose should be evaluated.

II. Diarrhea

Observation and recording: Pay attention to the frequency and character of bowel movements; mild cases are mostly self-limiting, and attention should be paid to distinguishing them from infectious diarrhea.

Fluid replacement to prevent dehydration: Drink more water or oral rehydration salts to maintain water and electrolyte balance, and keep the diet light with less greasy food.

Symptomatic medication: Use antidiarrheal drugs according to the physician's instructions when necessary, and avoid long-term self-medication abuse.

Be alert to worsening: Seek medical attention promptly when bloody stool, high fever, severe abdominal pain, or signs of dehydration occur, and suspend medication when necessary.

III. Bruising and bleeding tendency

Recognize the risk: BTK inhibitors can affect platelet function, manifesting as easy bruising, gum bleeding, or epistaxis.

Prevent trauma: Move gently in daily activities, use a soft-bristled toothbrush and an electric razor, and avoid severe collisions and high-risk sports.

Use medications with caution: Avoid self-administration of antiplatelet or anticoagulant drugs such as aspirin and ibuprofen, and consult a physician before concomitant use.

Surgical precautions: Inform the physician of the medication situation before tooth extraction or surgery; medication usually needs to be suspended in advance.

Seek medical attention promptly: Immediately seek medical care when large bruises, persistent bleeding, or hematuria and melena occur.