Severe Decrease of Cyclosporine Levels in a Heart Transplant Recipient Receiving the Direct Thrombin Inhibitor Argatroban

Sanchez, Romain; Picard, Nicolas; Mouly-Bandini, Annick; Chalvignac, Virginie; Lacarelle, Bruno; Sampol-Manos, Emmanuelle

doi:10.1097/ftd.0000000000000026

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…However, there is a very recent case report in which a severe decrease of cyclosporine levels was described in a 60-year-old patient receiving argatroban after a second heart transplant. Possible mechanisms of interaction are considered, such as an analytical interference, an idiopathic hemodilution, an increase of renal and hepatic clearance, and a metabolic drug–drug interaction 29. Furthermore, there have been several studies that characterize the pharmacokinetic and pharmacodynamic properties of argatroban in vulnerable patient groups, ie, elderly patients and patients with renal and/or hepatic dysfunction.…”

Section: Argatroban: Pharmacology and Pharmacokineticsmentioning

confidence: 99%

Update on argatroban for the prophylaxis and treatment of heparin-induced thrombocytopenia type II

Grouzi

2014

JBM

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Heparin-induced thrombocytopenia (HIT) is a rare but potentially severe complication of heparin therapy that is strongly associated with venous and arterial thrombosis (HIT and thrombosis syndrome, HITTS), which requires urgent detection and treatment with a nonheparin anticoagulant. Argatroban, a synthetic direct thrombin inhibitor, is indicated for the treatment and prophylaxis of thrombosis in patients with HIT, including those undergoing percutaneous coronary intervention. Argatroban has a relatively short elimination half-life of approximately 45 minutes, which is predominantly performed via hepatic metabolism. It is derived from L-arginine that selectively and reversibly inhibits thrombin, both clot-bound and free, at the catalytic site. Argatroban anticoagulation has been systematically studied in patients with HIT and HITTS and proved to be a safe and effective agent for this indication. The current review presents the pharmacology of argatroban, data regarding monitoring of the agent, and an overview of the results of the major clinical trials assessing argatroban anticoagulation in HIT patients. Additionally, data from recent clinical trials with argatroban use in more special indications such as in percutaneous coronary intervention, liver dysfunction, renal replacement therapy, and intensive care medicine, are reviewed. The approved initial dosage of argatroban for adults with HIT or HITTS is 2 μg/kg/minute for patients with normal hepatic function and 0.5 μg/kg/minute for patients with hepatic dysfunction. There is evidence that a reduced initial dose may also be advisable for patients with heart failure, multiple organ dysfunction, severe anasarca, or after cardiac surgery. Given this information, argatroban can be effectively used in treating HIT with monitoring of activated partial thromboplastin time.

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Section: Argatroban: Pharmacology and Pharmacokineticsmentioning

confidence: 99%

Update on argatroban for the prophylaxis and treatment of heparin-induced thrombocytopenia type II

Grouzi

2014

JBM

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“…Very different genetic markers such as HLA, POR*28 allele, ABCB1, NFKB1, and many more genotypes (97-99) play a great role in disease and CsA level (98,100), which seem to be of clinical significance. Therapeutic CsA monitoring is still need to adjust CsA dosing after administration of individualized doses (18) also time, other medication and sex differences in cyclosporine pharmacokinetics and ABCB1 gene expression in mononuclear blood cells in African American and Caucasian renal transplant recipients has great impact on CsA blood level that attenuate significance of individual therapy (101)(102)(103). Some data suggests more attention to genetically like NFAT (104) Sommerer C showed NFAT-monitoring has the potential to support pharmacokinetic monitoring during the early post-transplant period (105), however, others like Moes says that dose individualization of Cyclosporine A based on CYP3A4*22 is not indicated (106).…”

Section: Individualizing Target Range and Adjusting Dose Of Cyclosporinementioning

confidence: 99%

A Systematic Review about an Advance in Cyclosporine Monitoring in Kidney Transplant Recipients

Einollahi

Teimoori

2017

Nephro-Urol Mon

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Context: An immunosuppressive drug, Cyclosporine (CsA), has been commonly used in kidney transplants. A safe dosing of CsA often causes nephrotoxity, bone marrow toxicity, and infection. Pharmacokinetic characteristics of CsA and CsA marker relation to the immune suppression have not been completely described in clinical practices yet. Objectives: This review summarizes our achievements on pharmacokinetic and CsA level Marker in kidney transplant patients. Search methods and Selection criteria: A literature review was done using the National Center for Biotechnology Information's Pubmed Medline, Ovid Medline and Embase, and Iranian registries (Iranmedex, SID, MagIran, and IranDoc). Titles and abstracts were then reviewed to select studies based upon the predefined inclusion criteria. Our study defined a population of adult solid organ transplant recipients receiving the cyclosporine that Cyclosporine monitoring was done. Data Collection and Analysis: Two reviewers independently appraised the quality of each trial and extracted the data from the included trials. Results: CsA pharmacokinetics is very different between kidney transplant recipients, in order to CsA profiling, no pharmacodynamic tools has been confirmed yet in clinical practices and the best way to individualize calcineurin inhibitor therapy is still a controversial issue. C0 levels do not exactly predict the CsA level or rejection risk, patient monitored by C2 levels have upper doses of CsA and have a lower frequency of early acute allograft rejection than patients profiled with C0 and although CA is highly heterogeneous closely post-transplant and seems to be unhelpful early after post-transplant it is more favorable after first months after. Conclusions: Establishing a biological CsA marker may be helpful in clinical decisions on the dose. It seemed to be logical that we should re-inspect the possibility of using them as a supplementary tool towards better therapeutic drug monitoring of cyclosporine or it needs to be reevaluated and needs to find a new target for a therapeutic plan in kidney transplant patients.

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Argatroban/ciclosporin interaction

2014

Reactions Weekly

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Severe Decrease of Cyclosporine Levels in a Heart Transplant Recipient Receiving the Direct Thrombin Inhibitor Argatroban

Cited by 5 publications

References 13 publications

Update on argatroban for the prophylaxis and treatment of heparin-induced thrombocytopenia type II

Update on argatroban for the prophylaxis and treatment of heparin-induced thrombocytopenia type II

A Systematic Review about an Advance in Cyclosporine Monitoring in Kidney Transplant Recipients

Argatroban/ciclosporin interaction

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