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Titolo:
Therapeutic drug monitoring for immunosuppressants
Autore:
Wong, SHY;
Indirizzi:
Med Coll Wisconsin, Dept Pathol, Milwaukee, WI 53206 USA Med Coll Wisconsin Milwaukee WI USA 53206 Pathol, Milwaukee, WI 53206 USA Milwaukee Cty Med Examiners Off, Dept Toxicol, Milwaukee, WI 53223 USA Milwaukee Cty Med Examiners Off Milwaukee WI USA 53223 ukee, WI 53223 USA
Titolo Testata:
CLINICA CHIMICA ACTA
fascicolo: 1-2, volume: 313, anno: 2001,
pagine: 241 - 253
SICI:
0009-8981(200111)313:1-2<241:TDMFI>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
PERFORMANCE LIQUID-CHROMATOGRAPHY; TANDEM MASS-SPECTROMETRY; ACID-INDUCED IMMUNOSUPPRESSION; RENAL-TRANSPLANT RECIPIENTS; MICROPARTICLE ENZYME-IMMUNOASSAY; TACROLIMUS-II ASSAY; MYCOPHENOLIC-ACID; WHOLE-BLOOD; PHARMACODYNAMIC ASSESSMENT; CLINICAL PHARMACOKINETICS;
Keywords:
immunosuppressants; tacrolimus; cyclosporine; mycophenolic acid mofetil; rapamycin; drug monitoring; immunoassays;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
93
Recensione:
Indirizzi per estratti:
Indirizzo: Wong, SHY Med Coll Wisconsin, Dept Pathol, POB 26509, Milwaukee, WI 53206 USA Med Coll Wisconsin POB 26509 Milwaukee WI USA 53206 WI 53206 USA
Citazione:
S.H.Y. Wong, "Therapeutic drug monitoring for immunosuppressants", CLIN CHIM A, 313(1-2), 2001, pp. 241-253

Abstract

Background: Immunosuppressants have significantly increased patient survival, e.g. in renal transplant up to 90% for the first year. Methods: Four immunosuppressants are used for clinical applications in the United States: cyclosporine (CsA) (Sandimmune and Neoral), FK 506-tacrolimus (ProGraf), mycophenolic mofetil (CellCept)-the prodrug for the mycophenolic acid (MPA), and rapamycin (RAPA) (Sirolimus). For CsA and FK 506, the rationale for monitoring is due to the variable pharmacokinetics, acute infection, dosage adjustment, non-compliance check, and for long-term maintenance therapy. Targeted whole blood concentrations ranges are: for CsA, 100-400 ng/ml dependingon the methods, therapy and organs; and for FK 506, 5-20 ng/ml. For MPA, drug bioavailability-the plasma area-under-curve up to 12 h of 32.2-60.6 mg h/1 was correlated to the biopsy-proven rejection rate of < 10%. Monitoringis advocated for liver and renal transplants, for pediatrics, and for checking for non-compliance. RAPA monitoring is useful to check for variable pharmacokinetics, for non-compliance and others. The therapeutic range is tentatively targeted for 5-15 ng/ml. Monitoring methodologies are: for CsA, immunoassays such as fluorescence polarization immunoassay, and liquid chromatography (LC); for FK 506, microparticle enzyme immunoassay (MEIA); for MPA, enzyme multiplied immunoassay and LC; and for RAPA, MEIA, LC and LC-mass spectrometry. Proficiency survey programs for CsA and FK 506 are available from the US and Europe. Conclusions: Monitoring of immunosuppressants has become an essential adjunct to the drug therapy for organ transplant patients. (C) 2001 Elsevier Science B.V. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/03/20 alle ore 11:20:43