[Therapeutic Drug Monitoring of Immunosuppressive Drugs].

Abstract

Calcineurin inhibitors, cyclosporine and tacrolimus, and everolimus are used to prevent reactions following organ transplantation. However, these immunosuppressive drugs have narrow therapeutic ranges, and their inter- and intra-individual pharmacokinetics differ greatly. Therefore, daily doses must be adjusted accord- ing to blood trough concentrations. Although mycophenolate mofetil is generally used in a fixed dosing strategy, the need for more accurate drug dosing has become evident. A number of clinical factors, such as the time from transplantation, patient age and ethnicity, food consump- tion, albumin and hematocrit values, liver function, gastrointestinal motility, concomitant medication, and genetics, may affect the pharmacokinetics of immunosuppressive agents. The Japanese Society of Therapeutic Drug Monitoring (JSTDM) and the Japanese Society of Transplantation (JST) have developed and launched the first TDM guidelines to standardize routine TDM practice for immu- nosuppressive drugs used in kidney, liver and heart transplantation. These guidelines describe a consensus document among transplantation experts of the JST and TDM experts of the JSTDM. In the main part of this document, the TDM guidelines for immunosuppressive drugs are summarized and described. [Review].