Therapeutic Drug Monitoring of Immunosuppressant Drugs

Blood concentrations of cyclosporine, tacrolimus, sirolimus, everolimus, and mycophenolic acid are routinely monitored at transplant centers for several reasons including avoiding rejection because of subtherapeutic levels of these drugs as well as to avoid drug toxicity. Although whole blood concentration of cyclosporine, tacrolimus, sirolimus, and everolimus is usually determined in clinical laboratories for therapeutic drug monitoring, usually serum concentration of mycophenolic acid is measured. Therapeutic drug monitoring of immunosuppressant drugs is discussed in detail in Chapter 9. Therapeutic ranges and costs of monitoring immunosuppressants are given in Table 9.

Table 9

Therapeutic Drug Monitoring of Immunosuppressants

Table 9

Therapeutic Drug Monitoring of Immunosuppressants

Drug

Specimen Requirement

Therapeutic Rangeb Trough

Costa

Cyclosporine

Whole blood (EDTA)

100-400 ng/mL

$$

Tacrolimus

Whole blood (EDTA)

5-15 ng/mL

$$$

Mycophenolic acid

Serum or plasma

1-3.5 ^g/mL

$$$$

Everolimus

Whole blood (EDTA)

5-15 ng/mL

$$$$

Sirolimus

Whole blood (EDTA)

4-20 ng/mL

$$$

EDTA, ethylenediaminetetraacetic acid. a $, < $75; $$, < $100; $$$, > $100; $$$$, > $150; The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges only and may alter significantly with transplant type and with combination of other immunosuppressants.

EDTA, ethylenediaminetetraacetic acid. a $, < $75; $$, < $100; $$$, > $100; $$$$, > $150; The costs are based on published charge for these tests in our hospital laboratory and reference laboratories.

b Therapeutic ranges are suggested ranges only and may alter significantly with transplant type and with combination of other immunosuppressants.

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