How to handle missed or delayed doses of tacrolimus in renal transplant recipients? A pharmacokinetic investigation.

摘要: Every transplant patient will, at least occasionally, miss immunosuppressive drug doses or take them outside the prescribed times. This study aims quantifying impact of poor execution on tacrolimus exposure in renal patients. Validated pharmacokinetic tools applied clinical setting were used to simulate steady-state profiles when given as immediate-release formulation patients, being CYP3A5 expressors not, and who have reached either a standard minimized exposure. Situations interruption due missed delayed dose simulated was explored. In case dose, it observed that: (i) single forgotten can greatly exposure: up 49% decrease for trough concentration 70% AUC0-12 h patients with highest clearance values; (ii) are most affected by dose; (iii) 1.5 times usual may be recommended after total oversight. Considering that intra-patient variability is predictive factor graft outcome, these modeling results serve recommendations both preventively response their questions.