Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit.

Autor:	Bacopoulos AJ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.; Department of Pharmacy, University Health Network, Toronto, Canada., Ho L; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.; Department of Pharmacy, University Health Network, Toronto, Canada.; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada., Yang A; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.; Department of Pharmacy, University Health Network, Toronto, Canada., Ng P; Department of Pharmacy, University Health Network, Toronto, Canada., Dara C; Department of Pharmacy, University Health Network, Toronto, Canada., Loach D; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Deotare U; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Michelis FV; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Viswabandya A; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Kim DD; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Lipton JH; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Messner HA; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada., Thyagu S; Messner Allogeneic Transplant Program, University Health Network, Toronto, Canada.; Faculty of Medicine, University of Toronto, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners [J Oncol Pharm Pract] 2021 Jan; Vol. 27 (1), pp. 33-39. Date of Electronic Publication: 2020 Mar 17.
DOI:	10.1177/1078155220908948
Abstrakt:	At our institution, tacrolimus is used as a second-line agent for the prevention and treatment of graft-versus-host-disease in the allogeneic hematopoietic stem cell transplantation (HSCT) unit after patients have experienced a serious or intolerable adverse event to cyclosporine. As per our standard practice, tacrolimus is administered via 2-h intermittent IV infusions (IIVs) every 12 h rather than continuous IV infusion. Shorter infusion times are cautioned due to concerns of higher rates of nephrotoxicity, neurotoxicity and infusion-related reactions, although there is a paucity of data to support this claim. Our primary objective was to evaluate the safety of a 2-h IIV of tacrolimus in an adult HSCT population. We retrospectively reviewed the charts of 104 patients who received tacrolimus by IIV (3574 doses; median = 22, range 1-158, IQR = 28) from 2002 to 2016. Primary outcomes collected include rates of nephrotoxicity, neurotoxicity and infusion-related reactions. One (0.9%) grade 2 infusion-related reaction occurred and resolved without discontinuation of tacrolimus. Of 16 incidences (13.6%) of nephrotoxicity, all but 10 (8.5%) cases resolved. Precipitating factors for nephrotoxicity unrelated to tacrolimus were identified in all 10 cases. There were 41 incidences (35%) of neurotoxicity, of which, 8 (6.8%) were considered serious. All neurotoxicity reverted to baseline or resolved completely. We propose that a 2-h IIV of tacrolimus is a safe method of administration in the adult HSCT setting.
Databáze:	MEDLINE
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