Deneysel Bir Çalışma: Multivitaminler Takrolimus Düzeyinin, Parasetamol ve Trimetoprim Sülfametoksazol ise Siklosporin Düzeyinin Düşük Ölçülmesine Neden Oluyor

Abstract

İlaç-ilaç etkileşiminin aksine ilaç-kit etkileşimi birçok hekimin gözden kaçırdığı bir durumdur. Nakilden sonra immunsupresyon etkileri nedeniyle yaşam boyu kullanılan takrolimus, siklosporin gibi ilaçların etkinliği ve güvenliği büyük ölçüde plazma konsantrasyonlarına bağlı olup, doz ayarlaması kritik öneme sahiptir. Nakil sonrası dönemde kullanılan diğer ilaçlarla olan etkileşimler, takrolimus ve siklosporin ölçüm sonuçlarını değiştirebilir, tedavide yanlış doz ayarlamalarına yol açabilir. Çalışmada ilaçların takrolimus ve siklosporin ölçüm sonuçları üzerindeki etkilerini incelemek için16 farklı ilaç solüsyonu kullanıldı. Hazırlanan numuneler biyokimya analizöründe çalışıldı. Tüm ölçümler 20 kez tekrarlandı ve ortalama değerleri alındı. Elde edilen sonuçların hedef değerden ne oranda saptığını hesaplamak için bias (%) formülü kullanıldı. Takrolimus ölçümlerinde parasetamol dışındaki ilaçların oluşturduğu interferans anlamlı olarak saptandı (p<0,001). Multivitamin, en fazla sapmaya neden olan ilaçtı. Siklosporin konsantrasyonunda en fazla sapma trimetoprim sülfametoksazol ve parasetamol ile oldu. Siklosporinin, diğer ilaçların varlığında takrolimusa göre daha fazla ölçüm hatasına maruz kaldığı bulundu. Hastaların ve kan ilaç düzeylerinin sıkı takibi tedavinin güvenliğini artırmada kritik öneme sahiptir. Klinisyenin test sonuçlarını değerlendirirken immun assay yöntemlerin daha fazla farkında olması, çalışmalarla etkileşimleri gösterilmiş ilaçların laboratuvar sonucunu değerlendirirken güncel literatürü dikkate alarak yaklaşımı önemlidir.

Keywords

• Organ nakli
• immunsüpresif ilaçlar
• ilaç-ilaç etkileşimi

An Experimental Study: Multivitamins Cause Low Tacrolimus Levels, Paracetamol and Trimethoprim Sulfamethoxazole Cause Low Cyclosporine Levels

Abstract

Unlike drug-drug interactions, drug-kit interactions are a situation that many physicians overlook. The efficacy and safety of drugs such as tacrolimus and cyclosporine, which are used throughout life due to their immunosuppressive effects after transplantation, largely depend on plasma concentrations, and dose adjustment is of critical importance. Interactions with other drugs used in the post-transplant period can change the tacrolimus and cyclosporine measurement results and lead to incorrect dose adjustments in treatment. In the study, 16 different drug solutions were used to examine the effects of various drugs on the measurement results of tacrolimus and cyclosporine. The prepared samples were studied in the biochemistry analyzer. All measurements were repeated 20 times, and their average values were taken. The bias (%) formula was used to calculate the extent to which the obtained results deviated from the target value. In tacrolimus measurements, the interference caused by drugs other than paracetamol was significantly detected (p<0.001). Multivitamin was the drug that caused the most deviation. The highest deviation in cyclosporine concentration was with trimethoprim, sulfamethoxazole, and paracetamol. Cyclosporine was found to be subject to more measurement error than tacrolimus in the presence of other drugs. Close monitoring of patients and blood drug levels is critical to increasing the safety of treatment. It is essential for clinicians to be more aware of immunoassay methods when evaluating test results and to consider current literature when assessing laboratory results of drugs that have been shown to interact in studies.

Keywords

• Transplantation
• immunosuppression
• drug-drug interactions

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