Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series
Abstract Mycophenolate mofetil has an important role as immunosuppressive agent in solid organ transplant recipients. Exposure to the active mycophenolic acid (MPA) can be monitored using therapeutic drug monitoring. We present three cases in which MPA exposure severely decreased after oral antibiot...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-06-01
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| Series: | Pharmacology Research & Perspectives |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/prp2.1103 |
| _version_ | 1797800935589675008 |
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| author | Mirjam Simoons Kishan A. T. Naipal Huib deJong Caroline M. denHoed Brenda C. M. deWinter Midas B. Mulder |
| author_facet | Mirjam Simoons Kishan A. T. Naipal Huib deJong Caroline M. denHoed Brenda C. M. deWinter Midas B. Mulder |
| author_sort | Mirjam Simoons |
| collection | DOAJ |
| description | Abstract Mycophenolate mofetil has an important role as immunosuppressive agent in solid organ transplant recipients. Exposure to the active mycophenolic acid (MPA) can be monitored using therapeutic drug monitoring. We present three cases in which MPA exposure severely decreased after oral antibiotic coadministration. By diminishing gut bacteria β‐glucuronidase activity, oral antibiotics can prevent deglucuronidation of the inactive MPA‐7‐O‐glucuronide metabolite to MPA and thereby possibly prevent its enterohepatic recirculation. This pharmacokinetic interaction could result in rejection, which makes it clinically relevant in solid organ transplant recipients, especially when therapeutic drug monitoring frequency is low. Routine screening for this interaction, preferably supported by clinical decision support systems, and pragmatic close monitoring of the MPA exposure in cases is advised. |
| first_indexed | 2024-03-13T04:42:38Z |
| format | Article |
| id | doaj.art-c0238f5d29d14a3cbb864962b2176610 |
| institution | Directory Open Access Journal |
| issn | 2052-1707 |
| language | English |
| last_indexed | 2024-03-13T04:42:38Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pharmacology Research & Perspectives |
| spelling | doaj.art-c0238f5d29d14a3cbb864962b21766102023-06-19T04:55:55ZengWileyPharmacology Research & Perspectives2052-17072023-06-01113n/an/a10.1002/prp2.1103Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case seriesMirjam Simoons0Kishan A. T. Naipal1Huib deJong2Caroline M. denHoed3Brenda C. M. deWinter4Midas B. Mulder5Department of Hospital Pharmacy, ErasmusMC University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Internal Medicine, ErasmusMC University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Pediatrics, ErasmusMC Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The NetherlandsThe ErasmusMC Transplant Institute University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Hospital Pharmacy, ErasmusMC University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Hospital Pharmacy, ErasmusMC University Medical Center Rotterdam Rotterdam The NetherlandsAbstract Mycophenolate mofetil has an important role as immunosuppressive agent in solid organ transplant recipients. Exposure to the active mycophenolic acid (MPA) can be monitored using therapeutic drug monitoring. We present three cases in which MPA exposure severely decreased after oral antibiotic coadministration. By diminishing gut bacteria β‐glucuronidase activity, oral antibiotics can prevent deglucuronidation of the inactive MPA‐7‐O‐glucuronide metabolite to MPA and thereby possibly prevent its enterohepatic recirculation. This pharmacokinetic interaction could result in rejection, which makes it clinically relevant in solid organ transplant recipients, especially when therapeutic drug monitoring frequency is low. Routine screening for this interaction, preferably supported by clinical decision support systems, and pragmatic close monitoring of the MPA exposure in cases is advised.https://doi.org/10.1002/prp2.1103drug interactionsenterohepatic circulationmycophenolic acidorgan transplantationpatient safety |
| spellingShingle | Mirjam Simoons Kishan A. T. Naipal Huib deJong Caroline M. denHoed Brenda C. M. deWinter Midas B. Mulder Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series Pharmacology Research & Perspectives drug interactions enterohepatic circulation mycophenolic acid organ transplantation patient safety |
| title | Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series |
| title_full | Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series |
| title_fullStr | Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series |
| title_full_unstemmed | Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series |
| title_short | Oral antibiotics lower mycophenolate mofetil drug exposure, possibly by interfering with the enterohepatic recirculation: A case series |
| title_sort | oral antibiotics lower mycophenolate mofetil drug exposure possibly by interfering with the enterohepatic recirculation a case series |
| topic | drug interactions enterohepatic circulation mycophenolic acid organ transplantation patient safety |
| url | https://doi.org/10.1002/prp2.1103 |
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