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KMID : 0869620160330020152
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Journal of Korean Society of Hospital Pharmacists
2016 Volume.33 No. 2 p.152 ~ p.158
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Cyclosporine I.V. Dose Adjustment in Patients with Hematopoietic Stem Cell Transplantation
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Yoo Si-Hun
Hong So-Yeon
Jeon Su-Jeong
Namgung Hyung-Wook
Lee Eun-Sook
Lee Euni
Bang Su-Mi
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Abstract
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Background and purpose : Cyclosporine A (CsA) is the most used immunosuppressive agent to prevent grafts versus host diseases (GVHD) after allo-HSCT (Hematopoietic Stem Cell Transplantations). However, the pharmacokinetic and pharmacodynamic profiles of CsA are known to show individual variability. Our study is designed to document the CsA blood level and status of dose adjustment, and drug interactions between CsA and antifungal agents including ketoconazole and itraconazole.
Methods : A retrospective evaluation of the electronic medical records was conducted including adult patients who received allo-HSCT at Seoul National University Bundang Hospital from August 1, 2013 to August 31, 2015.
Results : A total of 30 patients were included in the study. On average, the starting dose of CsA was 4.9 mg/kg/days, 87 % of the patients did not reach the therapeutic goal. In order to reach the target blood level, patients were required up to three dose adjustments and 4.2 days. The proportion of the patients whose blood level was out of the target level was 66.7 %. Initial blood level and T1/2 of CsA among patients who concurrently used antifungal agents were higher than the control group.
Conclusion : Reevaluation of initial CsA IV dose and frequent therapeutic dose monitoring for concurrent use of CsA and antifungal agents are required for using the interdisciplinary team approach.
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KEYWORD
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Cyclosporine A (CsA), Hematopoietic stem cell transplantation (HSCT), Target blood level
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