Background Prerequisites for successful renal transplantation are stable and effective serum concentrations of immunosuppressive drugs such as ciclosporin, mycophenolate mofetil, tacrolimus (CMT). Drug-Drug-Interactions (DDIs) could change blood levels of CMT, potentially leading to toxicity or ineffective transplant function. Patient-specific information on potential DDIs is not accessible to surgical staff at the time of transplantation, when CMT is routinely started.
Purpose To identify and analyse the potential of DDIs of routine treatment with CMT in patients on the waiting list for renal transplantation through a systematic, standardised DDI check by a pharmacist, to increase patient safety.
Material and methods The current drug treatment of 136 patients was recorded. Potential DDIs of each drug with CMT were analysed using three DDI databases (Lexi-Interact, Drugdex, Stockley’s Drug Interactions) and the German SPC. For drugs not listed in these the Swiss-based MediQ-database was used. DDI severity was recorded according to the Lexi-Interact standard (A, D, X). An individual pharmacist-approved DDI risk profile of current drug treatment with CMT was prepared for each patient and made accessible at all times for the transplanting surgeon by adding it to the transplant record.
Results The patients (n = 136) reviewed (65% male, 35% female) had a mean age of 51 (±13 years), took a total of 225 different drugs. Patients took 2 to 22 different drugs (mean 10 ± 4).
Conclusion Starting CMT puts patients at risk of DDIs with concurrent drug treatments they are having for their comorbidities. Readily-accessible individual DDI risk evaluations prepared by drug information pharmacists may improve patient safety for renal transplant patients who are starting on CMT.
LebKuypers DJ. Immunotherapy in elderly transplant recipients. Drugs Aging 2009;26(9):715–37
ReferenceNo conflict of interest.
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