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Titolo:
Clinical pharmacokinetics of sirolimus
Autore:
Mahalati, K; Kahan, BD;
Indirizzi:
Univ Texas, Sch Med, Div Immunol & Organ Transplantat, Dept Surg, Houston,TX 77030 USA Univ Texas Houston TX USA 77030 splantat, Dept Surg, Houston,TX 77030 USA
Titolo Testata:
CLINICAL PHARMACOKINETICS
fascicolo: 8, volume: 40, anno: 2001,
pagine: 573 - 585
SICI:
0312-5963(2001)40:8<573:CPOS>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
PERFORMANCE LIQUID-CHROMATOGRAPHY; RENAL-TRANSPLANT RECIPIENTS; TANDEM MASS-SPECTROMETRY; MICROPARTICLE ENZYME-IMMUNOASSAY; THERAPEUTIC RANGE INVESTIGATIONS; ORALLY-ADMINISTERED SIROLIMUS; WHOLE-BLOOD; IMMUNOSUPPRESSANT SIROLIMUS; ULTRAVIOLET DETECTION; RADIORECEPTOR ASSAY;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
60
Recensione:
Indirizzi per estratti:
Indirizzo: Kahan, BD Univ Texas, Sch Med, Div Immunol & Organ Transplantat, Dept Surg, 6431 Fannin St,Suite 6-240, Houston, TX 77030 USA Univ Texas 6431 Fannin St,Suite 6-240 Houston TX USA 77030 0 USA
Citazione:
K. Mahalati e B.D. Kahan, "Clinical pharmacokinetics of sirolimus", CLIN PHARMA, 40(8), 2001, pp. 573-585

Abstract

Sirolimus (previously known as rapamycin), a macrocyclic lactone, is a potent immunosuppressive agent. Sirolimus was recently approved by the US Foodand Drug Administration, on the basis of 2 large, double-blind, prospective clinical trials, for use in kidney transplant recipients at a fixed dosage of 2 or 5 mg/day ir, addition to full dosages of cyclosporin and prednisone. However, despite the fixed dosage regimens used in these pivotal trials, pharmacokinetic and clinical data show that sirolimus is a critical-dose drug requiring therapeutic drug monitoring to minimise drug-related toxicities and maximise efficacy. Assays using high performance liquid chromatography coupled to mass spectrometry, although cumbersome, are the gold standard for evaluating other commonly used assays, such as liquid chromatography with ultraviolet detection, radioreceptor assay and microparticle enzyme immunoassay. Sirolimus is available in oral solution and tablet form. It has poor oral absorption and distributes widely in tissues, displaying not only a wide inter- and intrapatient variability in drug clearance, but also less than optimal correlations between whole blood concentrations and drug dose, demographic features or patient characteristics. Furthermore, the critical role ofthe cytochrome P450 3A4 system for sirolimus biotransformation leads to extensive drug-drug interactions, among which are increases in cyclosporin concentrations. Thus, sirolimus is now being used to reduce or eliminate exposure to cyclosporin or corticosteroids. The long elimination half-life of sirolimus necessitates a loading dose but allows once daily administration, which is more convenient and thereby could help to improve patient compliance. This review emphasises the importance of blood concentration monitoring inoptimising the use of sirolimus. The excellent correlation between steady-state trough concentration (at least 4 days after inception or, or change in, therapy) and area under the concentration-time curve makes the former a simple and reliable index for monitoring sirolimus exposure. Target trough concentration ranges depend on the concomitant immunosuppressive regimen, but a range of 5 to 15 mug/L is appropriate if cyclosporin is being used at trough concentrations of 75 to 150 mug/L. Weekly monitoring is recommended for the first month and bi-weekly for the next month; thereafter, concentration measurements are necessary only if warranted clinically.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 23/01/20 alle ore 06:51:37