Therapeutic Monitoring of Calcineurin Inhibitors for the Nephrologist
TLDR
The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications and discusses the effect of adjunctive immunosuppressive agents on CNI Pharmacokinetic and dosing.Abstract:
The calcineurin inhibitors (CNI) cyclosporine and tacrolimus remain the backbone of immunosuppression for most kidney transplant recipients. Despite many years of experience, protocols that optimize efficacy with minimal toxicity remain a subject of debate. Nevertheless, studies of the pharmacokinetic properties of the CNI, particularly cyclosporine, have led to improved dosing strategies. The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications. This article also reviews the trials that have helped to define the optimal dosages and discusses the effect of adjunctive immunosuppressive agents on CNI pharmacokinetics and dosing.read more
Citations
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Journal ArticleDOI
The First Asian Kidney Transplantation Prediction Models for Long-term Patient and Allograft Survival.
Suwasin Udomkarnjananun,Suwasin Udomkarnjananun,Natavudh Townamchai,Natavudh Townamchai,Stephen J. Kerr,Adis Tasanarong,Kajohnsak Noppakun,Adisorn Lumpaopong,Surazee Prommool,Thanom Supaporn,Yingyos Avihingsanon,Yingyos Avihingsanon,Kearkiat Praditpornsilpa,Somchai Eiam-Ong +13 more
TL;DR: This prediction model is the first based on an Asian population, can be used immediately after transplantation, and performed better when compared with a model based on US patients.
Journal ArticleDOI
Immunosuppression following organ transplantation. Part 2: complications and their management.
TL;DR: An overview of the issues involved in the care of patients who are receiving immunosuppressants is given, including the common complications encountered by post-transplant patients.
Journal ArticleDOI
Fatal water intoxication during olanzapine treatment: a case report.
TL;DR: The observation that excessive drinking behavior started after the dose of olanzapine was increased suggests a possibility that olanZapine aggravated water intoxication.
Journal ArticleDOI
Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients.
TL;DR: A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function, and the rate of appropriately drawn tacrolimus troughs significantly increased.
Journal ArticleDOI
Prospective multicenter randomized trial to compare incidence of new onset diabetes mellitus and glucose metabolism in patients receiving cyclosporine microemulsion versus tacrolimus after de novo kidney transplantation
Flavio Vincenti,Murat Tuncer,M Castagneto,Marian Klinger,Styrbjörn Friman,E. H. Scheuermann,Andrzej Wiecek,Graeme R. Russ,Arnošt Martínek,B Nonnast-Daniel +9 more
TL;DR: Pooled interim 3-month results from a subset of 115 patients receiving either tacrolimus or Neoral showed that the primary efficacy end-point (biopsy-proven acute rejection, graft loss or death) occurred in 11 patients, and there were four graft losses and only one death, which occurred after graft loss.
References
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Journal ArticleDOI
Cyclosporine-associated chronic nephropathy
TL;DR: It is concluded that long-term cyclosporine therapy may lead to irreversible and potentially progressive nephropathy and should be used with restraint and caution until ways are found to mitigate its nephrotoxicity.
Journal ArticleDOI
A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. FK506 Kidney Transplant Study Group
TL;DR: Tacrolimus is more effective than cyclosporine in preventing acute rejection in cadaveric renal allograft recipients, and significantly reduces the use of antilymphocyte antibody preparations.
Journal ArticleDOI
Cyclosporin a initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers
R.Y. Calne,Keith Rolles,Sathia Thiru,McMaster P,G.N. Craddock,S. Aziz,D.J.G. White,D. B. Evans,D.C Dunn,R.G. Henderson,P. Lewis +10 more
TL;DR: 34 patients treated with cyclosporin A received 36 cadaveric organ allografts, 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning.
Journal ArticleDOI
Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study
TL;DR: Use of sirolimus reduced occurrence and severity of biopsy-confirmed acute rejection episodes with no increase in complications and further studies are needed to establish the optimum doses for the combined regimen.
Journal ArticleDOI
Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection - A report of the European Tacrolimus Multicenter Renal Study Group
AD Mayer,Jean-Paul Squifflet +1 more
TL;DR: A significant reduction in the incidence of episodes of allograft rejection observed with tacrolimus therapy may have important long-term implications given the prognostic influence of rejection on graft survival.
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