TY - JOUR ID - 5047 TI - A Review on Therapeutic Drug Monitoring of Immunosuppressant Drugs JO - Iranian Journal of Basic Medical Sciences JA - IJBMS LA - en SN - 2008-3866 AU - Mohammadpour, Niloufar AU - Elyasi, Sepideh AU - vahdati, naser AU - Mohammadpour, Amir Hooshang AU - Shamsara, Jamal AD - Department of Microbiology, School of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran AD - Department of Pharmacodinamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran AD - Department of Pharmacodinamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences,Mashhad, Iran AD - Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran Y1 - 2011 PY - 2011 VL - 14 IS - 6 SP - 485 EP - 498 KW - Cyclosporine KW - Mycophenolic acid KW - Sirolimus KW - Tacrolimus KW - Therapeutic drug monitoring DO - 10.22038/ijbms.2011.5047 N2 - Immunosuppressants require therapeutic drug monitoring because of their narrow therapeutic index and significant inter-individual variability in blood concentrations. This variability can be because of factors like drug-nutrient interactions, drug-disease interactions, renal-insufficiency, inflammation and infection, gender, age, polymorphism and liver mass. Drug monitoring is widely practiced especially for cyclosporine, tacrolimus, sirolimus and mycophenolic acid. Cyclosporine Therapeutic monitoring of immunosuppressive therapy with cyclosporine is a critical requirement because of intra- and inter-patient variability of drug absorption, narrow therapeutic window and drug induced nephrotoxicity. Mycophenolic acid (MPA) Some reasons for therapeutic drug monitoring of MPA during post-transplant period include: relationship between MPA pharmacokinetic parameters and clinical outcomes, Inter-patient pharmacokinetic variability for MPA despite fixed MMF doses, alternations of MPA pharmacokinetics during the first months after transplantation, drug- drug interaction and influence of kidney function on MPA pharmacokinetic. Sirolimus A recent review of the pharmacokinetics of sirolimus suggested a therapeutic range of 5 to 10 pg l-1 in whole blood. However, the only consensus guidelines published on the therapeutic monitoring of sirolimus concluded that there was not enough information available about the clinical use of the drug to make recommendations. Tacrolimus Sudies have shown, in kidney and liver transplant patients, significant associations of low tacrolimus concentrations with rejection and of high concentrations with nephrotoxicity. Although the feasibility of a limited sampling scheme to predict AUC has been demonstrated, as yet, trough, or pre-dose, whole blood concentration monitoring is still the method of choice. UR - https://ijbms.mums.ac.ir/article_5047.html L1 - https://ijbms.mums.ac.ir/article_5047_4781aed2144481e8c9f5af32a31b2968.pdf ER -