Improved ability to achieve target trough levels with liquid versus capsule tacrolimus in kidney transplant patients with HIV on protease inhibitor‐ or cobicistat‐based regimens

2020 ◽  
Author(s):  
Uraiwan Akanit ◽  
Shahab Bozorgmehri ◽  
Kawther Alquadan ◽  
Joelle Nelson ◽  
Bruce Kaplan ◽  
...  
Keyword(s):  
Protease Inhibitor ◽  
Kidney Transplant ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Trough Levels

Variability of Mycophenolate Mofetil Trough Levels in Stable Kidney Transplant Patients

2007 ◽  
Vol 39 (7) ◽  
pp. 2185-2186 ◽  
Author(s):  
A. Fernández ◽  
J. Martins ◽  
J.J. Villlafruela ◽  
R. Marcén ◽  
J. Pascual ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Kidney Transplant ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Trough Levels

scholarly journals Drug-drug Interactions in Kidney Transplant Patients with Coronavirus Disease 2019: A Report of Two Cases and Literature Review

2021 ◽  
Keyword(s):  
Drug Interactions ◽  
Kidney Transplant ◽  
Mammalian Target Of Rapamycin ◽  
Graft Function ◽  
Gastrointestinal Symptoms ◽  
Treatment Protocol ◽  
Disease Spread ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Trough Levels

On February 19, 2020, the first confirmed case of Coronavirus disease 2019, known as COVID-19, was identified in Iran. Afterward, the disease spread rapidly throughout the country. Some of the cases were asymptomatic, some had mild to severe symptoms, and some of them died. Transplant patients are highly at risk due to long-term immunosuppressive therapy, and precise treatment approaches are needed to not only cure the disease but also protect graft function. This study reports two kidney transplant patients with COVID-19 pneumonia, both of whom showed respiratory and gastrointestinal symptoms. High cyclosporine and tacrolimus trough levels were observed despite initial dose reduction. After a treatment program containing reduced immunosuppressant dose and the addition of pulsatile hydrocortisone, these patients recovered effectively. We also discuss the importance of drug-drug interactions related to COVID-19 treatment protocol medications, especially with immunosuppressants, in these patients. In conclusion, frequent monitoring of the trough levels of calcineurin and mammalian target of rapamycin inhibitors during hospitalization is recommended since it helps to determine the ideal treatment and prevent serious clinical toxicity.

scholarly journals Tacrolimus Therapeutic Drug Monitoring in Kidney Transplant Patients Before and After Pharmacist Post-transplant Consults

2021 ◽  
Vol 12 (3) ◽  
pp. 18
Author(s):  
Gabriella Massoglia ◽  
Michael J. Schuh
Keyword(s):  
Kidney Transplant ◽  
Clinical Pharmacist ◽  
Therapeutic Drug ◽  
Improvement Project ◽  
Drug Levels ◽  
Post Transplant ◽  
Transplant Patients ◽  
Number Of Patients ◽  
Kidney Transplant Patients ◽  
Trough Levels

Objectives: This quality improvement project sought to determine if clinical pharmacist office visits, or consults, had an impact on therapeutic tacrolimus levels in patients after kidney transplant through analysis of tacrolimus serum concentrations before versus after a pharmacist visit. Methods: A retrospective chart review was conducted for all patients that attended a clinical pharmacist office visit, also known as a consult, after kidney transplantation for a four month period. Pharmacists during the post-transplant consult reviewed adherence but also educated patients in detail about timing and logging of tacrolimus dosing, dosing with regard to labs to assure trough dosing, dosing with or without food in the stomach, what to do with a dose is taken late or if a dose is missed and foods, herbal supplements to avoid that may inhibit CYP3A4 to elevate tacrolimus levels. Results: After the post-transplant visit with a clinical pharmacist there was a 46% increase in the number of tacrolimus trough levels in therapeutic range versus before the pharmacist visit. Sixty-four percent of kidney transplant patients experienced an increase in the number of therapeutic drug levels in range after the pharmacist visit versus before the pharmacist visit. Conclusions: An increase in the quantity of therapeutic tacrolimus trough levels and the number of patients with therapeutic drug levels in range was observed after patients received pharmacist provided medication education post-transplant with emphasis on proper immunosuppressant medication administration, adherence and potential drug and food interactions. This finding demonstrates the importance of pharmacist clinical services in producing improved therapeutic drug levels in post-transplant kidney patients.

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