Safety of two-hour intermittent intravenous infusions of tacrolimus in the allogeneic hematopoietic stem cell transplantation unit
| Autor: | Fotios V. Michelis, Santhosh Thyagu, Alexander Js Bacopoulos, Lina Ho, David Loach, Celina Dara, Anjie Yang, Pamela Ng, Hans A. Messner, Jeffrey H. Lipton, Dennis Dong Hwan Kim, Uday Deotare, Auro Viswabandya |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Adolescent medicine.medical_treatment Graft vs Host Disease chemical and pharmacologic phenomena Hematopoietic stem cell transplantation Tacrolimus Nephrotoxicity Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Pharmacology (medical) Infusions Intravenous Aged Retrospective Studies Infusion time business.industry Incidence Hematopoietic Stem Cell Transplantation Intravenous Infusions Acute Kidney Injury Middle Aged surgical procedures operative Oncology 030220 oncology & carcinogenesis Anesthesia Cyclosporine Female Patient Safety Nervous System Diseases business Immunosuppressive Agents 030215 immunology |
| Zdroj: | Journal of Oncology Pharmacy Practice. 27:33-39 |
| ISSN: | 1477-092X 1078-1552 |
| Popis: | 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: | OpenAIRE |
| Externí odkaz: |
|