Organ transplant drugs

Goa KL. Cyclosporin an updated review of the pharmacokinetic properties, clinical efficacy and tolerability of a microemulsion-based formulation (neoral)l in organ transplantation. Drugs. 2001 61 1957-2016. 

Spencer CM, Goa KL, Gilhs JC. Tacrolimus. An update of its pharmacology and clinical efficacy in the management of organ transplantation. Drugs 1997 54 925-975. 

Scott LJ, McKeage K, Keam SJ, and Plosker GL. 2003. Tacrolimus a further update of its use in the management of organ transplantation. Drugs 63 1247-1297. 

The most commonly used corticosteroids are methylpred-nisolone (IV and oral) and prednisone (oral), although prednisolone and dexamethasone also have been shown to be effective for organ transplantation. Corticosteroid doses vary by center-specific protocols, organ type, and patient characteristics. A typical taper would include an IV 100 to 500 mg bolus of methylprednisolone at the time of transplant and then a taper over 5 to 7 days to a maintenance dose of prednisone 20 mg/day or complete cessation.2,7 It is important for practitioners to know that approximately 4 mg methylprednisolone is equivalent to 5 mg prednisone and 0.75 mg dexamethasone.11 At most transplant centers, therapeutic drug monitoring of corticosteroids is not employed. Corticosteroids are associated with a variety of acute and chronic toxicides. The most common adverse events have been summarized in Table 52-5. 

Provide patient education in regard to the organ transplant, the complications associated with transplantation, the need for lifestyle modifications to reduce the risk of the complications (e.g., wear sunscreen, low-sodium diet), and drug therapy. 

In some surgical procedures, such as organ transplantation, the success of that procedure will be only as great as the course of pharmacotherapy that follows. Organ transplant recipients are required to continue drug therapy for the balance of their lives for control of their immune systems and to prevent organ rejection. 

Corticosteroids also exert inhibitory effects on the overall immune process. These drugs impair the function of the leukocytes responsible for antibody production and destruction of foreign cells. As a result, corticosteroids are also used therapeutically in the prevention of organ transplant rejection. 

Mycophenolate sodium (62 Myfortic Norvatis, 2003) is an immunosuppressant drug used to prevent rejection in organ transplantation. It is a selective, noncompetitive, reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH), the rate-limiting enzyme in the de novo pathway of guanosine nucleotide synthesis. Thus, mycophenolic acid (61), originally... 

Bardsley-Elhot A, Noble S, Foster RH. (1999) Mycophenolate mofetil A review of its use in the management of solid organ transplantation. Bio Drugs 12 363 10. 

It is evident that immunopharmacological drugs are of great significance in diseases of the immune system, organ transplants, viral infections, and in particular, in the treatment of AIDS. 

Only physicians experienced in immunosuppressive therapy and management of organ transplant patients should prescribe daclizumab. The physician responsible for daclizumab administration should have complete information requisite for the follow-up of the patient. Daclizumab should only be administered by health care personnel trained in the administration of the drug who have available adequate laboratory and supportive medical resources. 

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