The pharmacokinetic interaction between highly active antiretroviral therapy (HAART) and immunosuppressive drugs is a critical element in the management of patients with human immunodeficiency virus infection who undergo orthotopic liver transplantation (OLT). We describe the effect of the coadministration of Amprenavir/Ritonavir (APV/r) and FosAmprenavir (FosAPV) on cyclosporine (CsA) concentrations in two patients receiving OLT for end-stage liver disease due to hepatitis C Virus. Patient 1, who was maintained on 300 mg CsA twice a day with a trough concentration (C-trough) around 250 ng/mL, restarted HAART 12 days after transplantation with 300 mg APV/r twice a day with corresponding APV C-trough of 5293 ng/mL and RTV C-tough of 186 ng/mL. Forty-eight hours after initiation of HAART, C-trogh of CsA was 1200 mg/mL, so it was necessary to reduce the CsA dosage 12-fold (50 mg every day) to achieve a therapeutic effect. In Patient 2, who was maintained on 300 mg CsA twice a day and a corresponding C-trough of 400 ng/mL, HAART was restarted 12 days post-OLT with FosAPV 1400 mg twice a day. After 48 hours C-trough of CsA was around 600 ng/mL and C-trough of FosAPV, 1221 ng/mL. In this case it was necessary to reduce the CsA administration 3.5-fold (175 mg every day). In conclusion, therapeutic drug monitoring was necessary to monitor HAART and CsA post-OLT to prevent toxicity due to both therapies. The use of FosAPV without ritonavir boostering is sufficient to maintain adequate CsA blood concentrations, avoiding any event of toxicity.

Pharmacokinetic interaction between amprenavir/ritonavir and FosAmprenavir on cyclosporine in two patients with human immunodeficiency virus infection undergoing orthotopic liver transplantation / Guaraldi, Giovanni; S., Cocchi; M., Codeluppi; DI BENEDETTO, Fabrizio; S., Bonora; A., Motta; K., Luzi; M., Pecorari; W., Gennari; Masetti, Michele; Gerunda, Giorgio Enrico; Esposito, Roberto. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 38(4):(2006), pp. 1138-1140.

Pharmacokinetic interaction between amprenavir/ritonavir and FosAmprenavir on cyclosporine in two patients with human immunodeficiency virus infection undergoing orthotopic liver transplantation

GUARALDI, Giovanni;DI BENEDETTO, Fabrizio;MASETTI, Michele;GERUNDA, Giorgio Enrico;ESPOSITO, Roberto
2006-01-01

Abstract

The pharmacokinetic interaction between highly active antiretroviral therapy (HAART) and immunosuppressive drugs is a critical element in the management of patients with human immunodeficiency virus infection who undergo orthotopic liver transplantation (OLT). We describe the effect of the coadministration of Amprenavir/Ritonavir (APV/r) and FosAmprenavir (FosAPV) on cyclosporine (CsA) concentrations in two patients receiving OLT for end-stage liver disease due to hepatitis C Virus. Patient 1, who was maintained on 300 mg CsA twice a day with a trough concentration (C-trough) around 250 ng/mL, restarted HAART 12 days after transplantation with 300 mg APV/r twice a day with corresponding APV C-trough of 5293 ng/mL and RTV C-tough of 186 ng/mL. Forty-eight hours after initiation of HAART, C-trogh of CsA was 1200 mg/mL, so it was necessary to reduce the CsA dosage 12-fold (50 mg every day) to achieve a therapeutic effect. In Patient 2, who was maintained on 300 mg CsA twice a day and a corresponding C-trough of 400 ng/mL, HAART was restarted 12 days post-OLT with FosAPV 1400 mg twice a day. After 48 hours C-trough of CsA was around 600 ng/mL and C-trough of FosAPV, 1221 ng/mL. In this case it was necessary to reduce the CsA administration 3.5-fold (175 mg every day). In conclusion, therapeutic drug monitoring was necessary to monitor HAART and CsA post-OLT to prevent toxicity due to both therapies. The use of FosAPV without ritonavir boostering is sufficient to maintain adequate CsA blood concentrations, avoiding any event of toxicity.
38(4)
1138
1140
Pharmacokinetic interaction between amprenavir/ritonavir and FosAmprenavir on cyclosporine in two patients with human immunodeficiency virus infection undergoing orthotopic liver transplantation / Guaraldi, Giovanni; S., Cocchi; M., Codeluppi; DI BENEDETTO, Fabrizio; S., Bonora; A., Motta; K., Luzi; M., Pecorari; W., Gennari; Masetti, Michele; Gerunda, Giorgio Enrico; Esposito, Roberto. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 38(4):(2006), pp. 1138-1140.
Guaraldi, Giovanni; S., Cocchi; M., Codeluppi; DI BENEDETTO, Fabrizio; S., Bonora; A., Motta; K., Luzi; M., Pecorari; W., Gennari; Masetti, Michele; Gerunda, Giorgio Enrico; Esposito, Roberto
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/612837
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