Therapeutic Drug Monitoring - Is it Important for Newer Immunosuppressive Agents?

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Most patients who undergo solid organ transplantation require lifelong immunosuppressive therapy to prevent allograft rejection. But, because many immunosuppressive agents have narrow therapeutic ranges, and are associated with various toxicities and the potential for drug interactions, the use of therapeutic drug monitoring (TDM) in conjunction with clinical assessment of patients may be particularly important. This article reviews the role of, and factors pertinent to, TDM of the newer immunosuppressive agents tacrolimus (FK-506), sirolimus (rapamycin) and mycophenolate mofetil (MMF) [see Differential features table].

variable and there is good correlation between high trough concentrations and toxicity. Currently, concentrations of mycophenolic acid (active metabolite of MMF) in plasma are not routinely monitored in patients receiving MMF but there is growing interest in the transplant community. Likewise, further investigation is needed before definitive recommendations can be made regarding TDM of sirolimus, although available data suggest drug concentrations may correlate with clinical endpoints.


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