Clinical Pharmacokinetics and Therapeutic Drug Monitoring Aspects of Mycophenolate in Post-Kidney Transplantation

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Patcharaporn Sudchada



Mycophenolic acid (MPA) is proved to be an effective immunosuppressive agent and has been widely used in combinations with other immunosuppressive agents to prevent allograft rejection in post-kidney transplantation. Since MPA has a narrow therapeutic window, therapeutic monitoring of the drug has been an important issue. Over the past decade, numerous studies have reported that the trough concentration of MPA is less suitable than the area under the drug concentration-time curve (AUC) as a parameter for the monitoring of MPA, due to poor relationship between the trough concentration and the efficacy and safety of the drug. Moreover, it has been noted that the pharmacokinetics of MPA has high inter- and intra-individual variabilities. Numbers of factors may have influences on MPA clinical pharmacokinetics including ethnicity, gender, renal and liver functions, time-post-transplant, serum albumin, co-morbidities, other immunosuppressive agents, and other non-immunosuppressive agents. Therefore, therapeutic drug monitoring of MPA is not routinely recommended in practice but may be beneficial in patients with high risk of immunologic response or drug toxicity. At present, monitoring through clinical responses is the best way in clinical practice.


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