Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil
Background: Administration of (val)acyclovir in combination with mycophenolate mofetil (MMF) can result in increased acyclovir plasma levels due to competition with acyclovir for renal tubular secretion. Several studies of pharmacokinetic interactions between acyclovir and MMF have been previously d...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Clinical Infection in Practice |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590170222000796 |
| _version_ | 1797893787471577088 |
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| author | F.A. Berger J.E. Nagtegaal M.M. Malingré |
| author_facet | F.A. Berger J.E. Nagtegaal M.M. Malingré |
| author_sort | F.A. Berger |
| collection | DOAJ |
| description | Background: Administration of (val)acyclovir in combination with mycophenolate mofetil (MMF) can result in increased acyclovir plasma levels due to competition with acyclovir for renal tubular secretion. Several studies of pharmacokinetic interactions between acyclovir and MMF have been previously described, however, they present conflicting results. Case report: We present two cases of male patients to whom a pharmacokinetic interaction occurred between (val)acyclovir and mycophenolate mofetil. Results: Case A developed an acyclovir through level of 3.5 mg/L on day 3 of his acyclovir treatment, which resulted in neurotoxicity attributed to acyclovir overdosing because of the pharmacokinetic interaction with MMF. Case B developed an acyclovir through level of 3.2 mg/L on day 4 of his acyclovir treatment, which was attributed to the pharmacokinetic interaction with MMF in combination with his poor renal function. No adverse side-effects occurred. Conclusion: Clinical decision support systems should be used to generate alerts when (val)acyclovir and MMF are co-administered in patients with renal impairment (eGFR < 60 ml/min/1,73 m2). By using early-stage therapeutic drug monitoring, dosages can be adjusted if necessary. |
| first_indexed | 2024-04-10T06:59:00Z |
| format | Article |
| id | doaj.art-93b46a0297fe48189674e5be24277019 |
| institution | Directory Open Access Journal |
| issn | 2590-1702 |
| language | English |
| last_indexed | 2024-04-10T06:59:00Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj.art-93b46a0297fe48189674e5be242770192023-02-28T04:09:05ZengElsevierClinical Infection in Practice2590-17022023-01-0117100211Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetilF.A. Berger0J.E. Nagtegaal1M.M. Malingré2Corresponding author at: Maatweg 3, 3813 TZ Amersfoort, The Netherlands.; Department of Clinical Pharmacy, Meander Medical Centre, Amersfoort, The NetherlandsDepartment of Clinical Pharmacy, Meander Medical Centre, Amersfoort, The NetherlandsDepartment of Clinical Pharmacy, Meander Medical Centre, Amersfoort, The NetherlandsBackground: Administration of (val)acyclovir in combination with mycophenolate mofetil (MMF) can result in increased acyclovir plasma levels due to competition with acyclovir for renal tubular secretion. Several studies of pharmacokinetic interactions between acyclovir and MMF have been previously described, however, they present conflicting results. Case report: We present two cases of male patients to whom a pharmacokinetic interaction occurred between (val)acyclovir and mycophenolate mofetil. Results: Case A developed an acyclovir through level of 3.5 mg/L on day 3 of his acyclovir treatment, which resulted in neurotoxicity attributed to acyclovir overdosing because of the pharmacokinetic interaction with MMF. Case B developed an acyclovir through level of 3.2 mg/L on day 4 of his acyclovir treatment, which was attributed to the pharmacokinetic interaction with MMF in combination with his poor renal function. No adverse side-effects occurred. Conclusion: Clinical decision support systems should be used to generate alerts when (val)acyclovir and MMF are co-administered in patients with renal impairment (eGFR < 60 ml/min/1,73 m2). By using early-stage therapeutic drug monitoring, dosages can be adjusted if necessary.http://www.sciencedirect.com/science/article/pii/S2590170222000796PharmacokineticsTherapeutic drug monitoringDrug interactions |
| spellingShingle | F.A. Berger J.E. Nagtegaal M.M. Malingré Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil Clinical Infection in Practice Pharmacokinetics Therapeutic drug monitoring Drug interactions |
| title | Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil |
| title_full | Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil |
| title_fullStr | Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil |
| title_full_unstemmed | Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil |
| title_short | Two cases of a pharmacokinetic interaction between (val)acyclovir and mycophenolate mofetil |
| title_sort | two cases of a pharmacokinetic interaction between val acyclovir and mycophenolate mofetil |
| topic | Pharmacokinetics Therapeutic drug monitoring Drug interactions |
| url | http://www.sciencedirect.com/science/article/pii/S2590170222000796 |
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