Absence of Pharmacokinetic Interference of Moxifloxacin on Cyclosporine and Tacrolimus in Kidney Transplant Recipients

Abstract

This study investigates the potential pharmacokinetic interactions between an antimicrobial agent, moxifloxacin, and 2 immunosuppressant drugs, cyclosporine and tacrolimus, in kidney transplant recipients. Twenty-two kidney transplant patients needing antibiotic therapy for urinary tract infections are enrolled. Eleven patients are under cyclosporine treatment and the other 11 patients are under tacrolimus treatment. Because the urinary tract infections are caused by gram-negative aerobes sensitive to moxifloxacin, this antibiotic is administered by oral route at a dose of 400 mg/d for 1 week; in each patient pharmacokinetic studies are carried out before and at the seventh day of therapy. For both immunosuppressors, none of the pharmacokinetic parameters investigated show statistically significant differences between values obtained before and during treatment with moxifloxacin. In fact, the concentration-time profiles of monoclonal cyclosporine, polyclonal cyclosporine, and tacrolimus are not significantly different before and during the antimicrobial therapy. The results of the present study rule out interference of moxifloxacin with both cyclosporine and tacrolimus kinetics and indicate that the concomitant administration of the fluoroquinolone and cyclosporine or tacrolimus does not require modifications of the dosages of 2 immunosuppressant drugs.

Pharmacokinetic Drug Interactions of Antimicrobial Drugs: A Systematic Review on Oxazolidinones, Rifamycines, Macrolides, Fluoroquinolones, and Beta-Lactams

“…Despite CYP3A4 involvement in the metabolism of cyclosporine, when CIP [310], MXF [311], or LVX [312], are co-administered with cyclosporine, no significant changes in cyclosporine exposure are observed in healthy volunteers [310,312] or patients [311]. The PK parameters of tacrolimus also remained unaffected after co-administration with MXF in a prospective cohort study that included 11 patients [311].…”

“…The PK parameters of tacrolimus also remained unaffected after co-administration with MXF in a prospective cohort study that included 11 patients [311]. Inhibition of CYP3A4 by FQs is therefore unlikely.…”

Liver transplantation is associated with good clinical outcome in patients with active tuberculosis and acute liver failure due to anti‐tubercular treatment

“…37,38 To date, no pharmacokinetic interactions between quinolones and immunosuppressive drugs have been reported. 39,40 However, the well-known issues with the prolonged use of FQ are the increased incidence of tenosynovitis and the risk of QT-interval prolongation. 39,41,42 These risks may be increased with the concomitant use of other drugs such as azoles, but could be prevented using alternative antifungal drugs.…”

Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients

“…This decision was supported by a previous study showing that OFLO was efficient and well tolerated, despite a possible interaction with cyclosporin A (20). (However, this interaction was recently reported to be limited [21]. ) The decision took effect on October 18, 2006.…”