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Population pharmacokinetic analysis of tacrolimus in Chinese cardiac transplant recipients

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机构: [1]Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [2]Department of Anesthesiology, Tianjin Eye Hospital, Tianjin, China [3]Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [4]Department of Pharmacy, Children’s Hospital of Fudan University, Shanghai, China [5]Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [6]Precision Medicine Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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关键词: body weight cardiac transplantation population pharmacokinetics post-operative day simulation tacrolimus wuzhi capsules

摘要:
Objective: Usage of tacrolimus is complicated by its narrow therapeutic index and wide between- and within-subject pharmacokinetic variability. We aimed to obtain more information regarding the influence of various covariates on the disposition of tacrolimus in the early phase after cardiac transplantation using a population pharmacokinetic method, and provide information for the individualisation of drug dosing in the clinical setting. Methods: Routine therapeutic drug monitoring concentrations (897 observations) were retrospectively collected from 146 hospitalised patients. One compartment model with first-order absorption (absorption rate constant K a was fixed as 4.48/hour) was employed to establish the population pharmacokinetic model using a non-linear mixed-effects modelling approach. Various demographic parameters, postoperative day and concomitant medications influencing drug clearance and distribution volume were investigated in this study. Bootstrap and prediction-corrected visual predictive check were employed to validate the final model. With the goal of tacrolimus trough concentrations within the therapeutic window, simulation was performed. Results: Pharmacokinetic parameter population typical estimates for clearance (CL/F) and apparent distribution volume (V/F) were 14.23 L/hour and 760.80 L, respectively. Postoperative day and co-administration of Wuzhi capsules were identified as important factors affecting CL/F. Total body weight was significantly associated with the V/F. Results of model evaluation indicated a good stable and precise performance of the final model. Based on the simulation results, a simple-touse dosage regimen table to guide clinicians with drug dosing was created. Conclusion: The final population model could provide information for the individualised dosing of tacrolimus for cardiac transplant recipients. © European Association of Hospital Pharmacists 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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出版当年[2018]版:
大类 | 4 区 医学
小类 | 4 区 药学
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 药学
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第一作者机构: [1]Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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通讯机构: [1]Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [5]Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [6]Precision Medicine Center for Neurological Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [*1]Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China [*2]Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China
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