Therapeutic drug monitoring of immunosuppressant drugs.

  title={Therapeutic drug monitoring of immunosuppressant drugs.},
  author={Atholl Johnston and David W Holt},
  journal={British journal of clinical pharmacology},
  volume={47 4},
  • A. JohnstonD. Holt
  • Published 1 April 1999
  • Medicine, Biology
  • British journal of clinical pharmacology
Individualizing a patient’s drug therapy to obtain the optimum balance between therapeutic efficacy and the occurrence of adverse events is the physician’s goal. However, achieving this goal is not always straight forward, being complicated by within and between patient variability in both pharmacokinetics and pharmacodynamics. In the early 1960s new analytical techniques became available allowing the measurement of the low drug concentrations seen in biological fluids during drug treatment… 

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Gr upSM Therapeutic Drug Monitoring of Immunosuppressive Agents

This chapter reviews the general principles of therapeutic drug monitoring of the immunosuppressive drugs: cyclosporine, tacrolimus, mycophenolic acid, sirolimus and everolimus.

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Critical Issues in Therapeutic Drug Monitoring of Antiretroviral Drugs

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Methods for Clinical Monitoring of Cyclosporin in Transplant Patients

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Therapeutic drug monitoring of antimetabolic cytotoxic drugs.

  • L. Lennard
  • Biology, Chemistry
    British journal of clinical pharmacology
  • 1999
Therapeutic drug monitoring is not routinely used for cytotoxic agents because of the lack of established therapeutic concentration ranges, but methotrexate is the only agent which is routinely monitored in most treatment centres.

Prospective investigations of concentration-clinical response for immunosuppressive drugs provide the scientific basis for therapeutic drug monitoring.

The application of the multicenter randomized concentration-controlled clinical trial study design, and related study designs, as applied to older commonly used and monitored drugs and to two new immunosuppressant drugs, mycophenolate mofetil and tacrolimus are discussed.

Pharmacodynamic assessment of mycophenolic acid-induced immunosuppression in renal transplant recipients.

The measurement of the pharmacodynamic response to Immunosuppressive drugs may provide not only a mechanism to predict the most appropriate dosing regimen, but also a viable alternative to traditional therapeutic drug monitoring, by assessing the overall state of immunosuppression.

Pharmacodynamic monitoring of immunosuppressive drugs.

AZA treatment of renal-transplant patients who exhibited an increase in thiopurine methyltransferase activity from time of transplantation resulted in fewer episodes of active rejection, and may provide an alternative approach to additional measurements of drug concentrations.

Use of Therapeutic Drug Monitoring in Pharmacoeconomics

Current literature with regard to pharmacoeconomics and cost-benefit analysis of TDM is discussed and the pharmacoeconomic benefits provided by this service to both in- and outpatients are discussed.

Therapeutic Drug Monitoring of Tacrolimus in Clinical Transplantation

Therapeutic drug monitoring is important to avoid unnecessary toxicity, but the lower limit has not been fully defined, clearly, many patients with <5 ng/ml have excellent hepatic function, although careful monitoring continues.

Concentration-Controlled Trials

The measurement of drug concentrations rationalises the sometimes criticised intention-to-treat analysis, and the potential benefits of concentration-controlled trials can be realised in a wider arena, the practical problems must be addressed.

Target Concentration Strategy for Cyclosporin Monitoring

  • R. Morris
  • Biology
    Clinical pharmacokinetics
  • 1997
The possibility of extending the target concentration concept to immunosuppressant monitoring with cyclosporin is raised for debate, where there has been considerable difficulty in establishing therapeutic ranges which are widely accepted and applied.