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      The influence of comedication on tacrolimus blood concentration in patients subjected to kidney transplantation: a retrospective study.

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          Abstract

          Tacrolimus is an immunosuppressant used for the prevention of kidney allograft rejection. The effects of comedication on tacrolimus trough concentrations (TTC) in kidney transplant recipients, subjected to basic immunosuppressant regime consisting of tacrolimus, corticosteroids and mycophenolate mofetil were investigated. This retrospective case series study involved 208 of these patients, with the outpatient examination recorded in the database of patients, at the unit of monitoring, with a total of 5,011 such examinations. Binary logistic regression analysis has shown that calcium channel blockers, diuretics and proton pump inhibitors (PPIs) significantly affected TTC (p < 0.001). PPIs significantly increased the number of examinations in which the TTC were in the recommended therapeutic range (from 5 to 15 ng/ml), as well as over the therapeutic range (p < 0.0001). When calcium channel blockers were added to PPIs, even more pronounced effect was obtained in comparison to triple-drug therapy only (p < 0.0001). In case a diuretic was given with a PPI, a significantly increased number of examinations with subtherapeutic TTC was observed when compared with PPI only (p = 0.0203). The combination of calcium channel blockers, diuretics and PPIs resulted in the number of examinations with TTC in the recommended therapeutic range not being different from the number of examinations with TTC in the triple-drug therapy only (p = 0.3829). β-adrenergic antagonists can be administered without fear of affecting the tacrolimus optimal therapeutic concentrations. This was confirmed with all combinations of the examined drugs used in patients subjected to kidney transplantation concomitantly with β blockers.

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          Author and article information

          Journal
          Eur J Drug Metab Pharmacokinet
          European journal of drug metabolism and pharmacokinetics
          Springer Nature America, Inc
          0378-7966
          0378-7966
          Dec 2014
          : 39
          : 4
          Affiliations
          [1 ] Centre for Transplantation of Solid Organs, Military Medical Academy, Belgrade, Serbia.
          Article
          10.1007/s13318-013-0168-3
          24356808
          ba218bf0-77b6-4bf5-9627-6f04be1cd962
          History

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