Sulfinpyrazone reduces cyclosporine levels: a new drug interaction in heart transplant recipients
| Autor: | Annalisa Angelini, E Pompei, Dino Casarotto, F Marchini, Luca Testolin, S. Dalla Volta, Antonio Gambino, G. Feltrin, Francesco Tona, Alida L.P. Caforio |
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| Rok vydání: | 2000 |
| Předmět: |
Pulmonary and Respiratory Medicine
Graft Rejection Male medicine.medical_specialty medicine.medical_treatment Allopurinol Urology chemistry.chemical_compound Risk Factors Internal medicine medicine Humans Urea Drug Interactions Hyperuricemia Heart transplantation Transplantation Creatinine business.industry Liter Middle Aged Uricosuric Agents medicine.disease Sulfinpyrazone Uric Acid Endocrinology chemistry Cyclosporine Uric acid Heart Transplantation Surgery Female Cardiology and Cardiovascular Medicine business Immunosuppressive Agents medicine.drug Follow-Up Studies |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 19(12) |
| ISSN: | 1053-2498 |
| Popis: | Background: Management of cyclosporine (CsA)–associated hyperuricemia in heart transplantation (HT) is difficult. Because of the myelotoxicity of combined allopurinol and azathioprine, we tested sulfinpyrazone. Methods We studied 120 HT recipients (109 men; mean age at HT, 52 ± 10 years). All had received allopurinol for at least 6 months, which was stopped for 1 month before initiation of sulfinpyrazone. Mean follow-up from HT to onset of sulfinpyrazone (200 mg/day) was 59 ± 41 months. We stopped the drug after 6 ± 2 months. We compared CsA level and daily dose, serum creatinine, blood urea, and uric acid at onset and before interruption of sulfinpyrazone and, as control, in the last 6 months of allopurinol. Results Mean uricemia decreased with allopurinol (0.58 ± 0.12 vs 0.41 ± 0.07 mmol/liter, p = 0.0001) as well as with sulfinpyrazone (0.51 ± 0.13 vs 0.40 ± 0.12 mmol/liter, p = 0.0001). Mean creatinine increased (171 ± 42 and 164 ± 35 μmol/liter, p = 0.01) with allopurinol, whereas it tended to decrease with sulfinpyrazone (160 ± 35 and 154 ± 48 μmol/liter, p = NS). Mean urea did not change with allopurinol (14 ± 5 vs 15 ± 7 mmol/liter, p = NS), but fell with sulfinpyrazone (14.01 ± 5 vs 12.60 ± 5 mmol/liter, p = 0.0004). Mean CsA levels were constant with allopurinol (193 ± 73 vs 188 ± 65 ng/ml, p = NS), although CsA dose was slightly reduced (2.7 ± 0.8 vs 2.6 ± 0.8 mg/kg/day, p = 0.007). Conversely, CsA levels dropped with sulfinpyrazone (183 ± 89 vs 121 ± 63 ng/ml, p = 0.0001) despite an increase in CsA daily dose (2.6 ± 0.9 vs 2.8 ± 0.9 mg/kg/day, p = 0.0001). Two subjects were treated for acute rejection. We observed no other side effects. Conclusions In HT recipients sulfinpyrazone, as an alternative to allopurinol, is effective in achieving metabolic control of hyperuricemia. However, this drug reduced CsA levels, thus the risk of rejection is present. |
| Databáze: | OpenAIRE |
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