Klin Farmakol Farm. 2017;31(3):3-6 | DOI: 10.36290/far.2017.032

Interakce mezi mykofenolát mofetilem a takrolimem u pacientů po transplantaci ledviny

Jan Strojil1, Jiří Orság2, Tomáš Fürst3, Karel Urbánek1, Pavel Anzenbacher1, Karel Krejčí2
1 Department of Pharmacology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
Department of Internal Medicine III – Nephrology, Rheumatology and Endocrinology, Faculty Hospital Olomouc,
2 Czech Republic
Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacký University Olomouc,
3 Czech Republic

Cíle: Takrolimus je základem imunosuprese u příjemců transplantované ledviny. Nejčastěji je užíván v kombinaci s mykofenolátmofetilem. Údaje o existenci a významu interakce těchto dvou léků u pacientů po transplantaci ledvin jsou protichůdné a nejednoznačné.Cílem této studie bylo potvrdit a kvantifikovat tuto interakci u pacientů po transplantaci ledvin.

Metody: Bylo analyzováno celkem 4 220 měření hladin takrolimu v období 5 let u 181 pacientů s renálním štěpem v jednomtransplantačním centru. Změna dávky potřebné k dosažení jednotkové koncentrace byla použita jako náhradní parametr propopis variability clearance léku. Regresní multivariační model byl sestaven tak, aby identifikoval významné prediktory dávkytakrolimu potřebné k dosažení jednotkové koncentrace.

Výsledky: Model identifikoval významné prediktory dávky takrolimu jako hematokrit, jaterní funkce, tělesnou hmotnost, věk pacientaa jeho dávku prednisonu. Koeficient dávky mykofenolátmofetilu byl -8,76e-04 (standardní chyba 1,35e-04, p < 0,001). Každé zvýšenídávky mykofenolátu o 1 000 mg tedy vedlo v průměru k 15,1% snížení dávky takrolimu potřebné k dosažení stejné koncentrace.

Závěr: Na základě naší analýzy je interakce mezi mykofenolát mofetilem a takrolimem, identifikovaná již dříve u pacientů potransplantaci jater, přítomna také u pacientů po transplantaci ledviny. Po prospektivní validaci by pro stanovení změn hladinytakrolimu po úpravě dávky mykofenolát mofetilu mohl být použit farmakokinetický model.

Keywords: mykofenolát mofetil, takrolimus, interakce, transplantace, terapeutické monitorování léků.

Received: September 23, 2017; Accepted: October 2, 2017; Published: November 1, 2017  Show citation

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Strojil J, Orság J, Fürst T, Urbánek K, Anzenbacher P, Krejčí K. Interakce mezi mykofenolát mofetilem a takrolimem u pacientů po transplantaci ledviny. Klin Farmakol Farm. 2017;31(3):3-6. doi: 10.36290/far.2017.032.
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