Why are some patients not recommended to take ponatinib?

Ponatinib is a third-generation tyrosine kinase inhibitor mainly used to treat patients with chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). It is especially suitable for patients who are resistant or intolerant to early tyrosine kinase inhibitors such as imatinib. However, because its mechanism of action involves the inhibition of multiple tyrosine kinases, there are certain risks in clinical use for some patients, so not all patients are suitable for taking it.

First, ponatinib is not recommended for patients with cardiovascular disease. This drug may increase the risk of cardiovascular events such as thrombosis, myocardial infarction, and stroke. For patients with a history of cardiovascular disease, poor blood pressure control, or a high risk of thrombosis, the use of ponatinib may cause serious complications. Doctors typically assess a patient's cardiovascular risk before treatment and consider alternatives or increased monitoring if necessary.

Secondly, patients with severe liver dysfunction or renal insufficiency should use it with caution or avoid use. Ponatinib is mainly excreted through liver metabolism. Impaired liver function may lead to accumulation of the drug in the body, increasing the risk of toxic reactions. At the same time, patients with renal insufficiency may also experience delayed drug clearance, thereby exacerbating adverse reactions, including bleeding tendencies and hematological abnormalities. Therefore, such patients need to weigh the pros and cons under the guidance of a professional doctor, and adjust the dosage or choose other drugs if necessary.

In addition, pregnant and lactating women are not suitable to take ponatinib. Existing data show that ponatinib may be potentially toxic to the fetus. Use during pregnancy may cause abnormal fetal development or pregnancy complications, and use during lactation may affect the health of the baby through milk. Therefore, such patients should take effective contraceptive measures or delay treatment, and choose safe alternative drugs under the guidance of a doctor. In general, although ponatinib has significant efficacy, its use requires strict screening of patients with indications and combined with individualized risk assessment to ensure drug safety.

Reference materials:https://www.drugs.com/