Real clinical impact of drug–drug interactions of immunosuppressants in transplant patients

Pharmacology Research & Perspectives

卷:9

Manuel Cárdenas¹  Ana Isabel Gago‐Sánchez¹  José Ramón Del Prado¹  María Dolores Aumente¹  Miguel Ángel Calleja²  Pilar Font³ 

[1] Pharmacy Department Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of Córdoba Córdoba Spain;

[2] Pharmacy Department Hospital Universitario Virgen Macarena Sevilla Spain;

[3] Rheumatology Department Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/University of Córdoba Córdoba Spain;

关键词: adverse drug events;    clinically relevant;    drug–drug interactions;    immunosuppressants;    prevalence;    transplant;   

DOI  :  10.1002/prp2.892

来源: DOAJ

【 摘 要 】

Abstract The main objective was to determine the prevalence of real drug–drug interactions (DDIs) of immunosuppressants in transplant patients. We conducted a prospective, observational 1‐year study at a tertiary hospital, including all transplanted patients. We evaluated data from monitoring blood concentrations of immunosuppressive drugs and adverse drug events (ADEs) caused by DDIs. The DDIs were classified as C, D, or X according to their Lexi‐Interact rating (C = monitor therapy, D = consider therapy modification, X = avoid combination). The clinical importance of real DDIs was expressed in terms of patient outcomes. The causality of DDIs was determined using Drug Interaction Probability Scale. The data were analyzed using Statistical Package for Social Sciences v. 25.0. A total of 309 transplant patients were included. Their mean age was 52.0 ± 14.7 years (18–79) and 69.9% were male. The prevalence of real DDIs was 21.7%. Immunosuppressive drugs administered with antifungal azoles and tacrolimus (TAC) with nifedipine have a great clinical impact. Real DDIs caused ADEs in 22 patients. The most common clinical outcome was nephrotoxicity (1.6%; n = 5), followed by hypertension (1.3%; n = 4). Suggestions for avoiding category D and X DDIs included: changing the immunosuppressant dosage, using paracetamol instead of non‐steroidal anti‐inflammatory drugs, and interrupting atorvastatin. The number of drugs prescribed and having been prescribed TAC was associated with an increased risk of real DDIs. There are many potential DDIs described in the literature but only a small percentage proved to be real DDIs, based on the patients´ outcomes.

【 授权许可】

Unknown