Pharmacotherapy Principles & Practice by Marie A. Chisholm-Burns & Terry L. Schwinghammer & Barbara G. Wells & Patrick M. Malone & Jill M. Kolesar & Joseph T. DiPiro

Author:Marie A. Chisholm-Burns & Terry L. Schwinghammer & Barbara G. Wells & Patrick M. Malone & Jill M. Kolesar & Joseph T. DiPiro
Language: eng
Format: mobi
Publisher: McGraw-Hill
Published: 2010-06-22T16:00:00+00:00

Pharmacodynamic Interactions

In addition to the numerous pharmacokinetic interactions seen with the maintenance immunosuppressants, there also exists the possibility for pharmacodynamic interactions. An in-depth review of pharmacodynamic interactions with maintenance immunosuppressive agents goes beyond the scope of this chapter. However, some common pharmacodynamic DDIs will be discussed. Pharmacodynamic interactions are the backbone of modern immunosuppressive therapies that employ multiple medications with different mechanisms of action resulting in additive immunosuppression. Unfortunately, pharmacodynamic interactions can also be problematic, such as when medications with similar adverse events are used concomitantly. For example, nephrotoxic agents, such as amphotericin B, amino-glysides (i.e., gentamicin, tobramicin, amikacin) and non-steroidal anti-inflammatory drugs (NSAIDs; i.e., napro xen, ibuprofen, ketorolac) may potentiate the nephrotoxic effects of the calcineurin inhibitors.9 The use of myelosuppressive agents, such as cotrimoxazole and valganciclovir, could enhance the myelosuppressive effects of induction therapy and the maintenance immunosuppressants.9

Table 55–6 Potential DDIs With the Calcineurin Inhibitors and Sirolimus Mediated Through the Cytochrome P-450 System 3A (CYP3A4) Isozyme

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