Renal Transplant Hastalarında İlaç-İlaç Etkileşimlerinin Değerlendirilmesi
Giriş: Dünya genelinde ve ülkemizde kronik böbrek yetmezlikli hasta sayısı her geçen gün artış göstermekte; bu hastaların artmış mortalite ve morbiditesinin olduğu da bilinmektedir. Bunun sonucu olarak renal replasman tedavisine ihtiyaç duyan hasta oranı da artmaktadır. Böbrek nakli renal replasman tedavileri içerisinde en normale yakın yaşam standardı sunan tedavi yöntemi olup bu grup hastanın düzenli immunsupresif tedaviyle birlikte pek çok ek ilaç kullanmakta olduğu da bilinmektedir. Bu çalışmada çoklu ilaç kullanımının olduğu renal transplantlı hastalardaki ilaç-ilaç etkileşimini araştırmayı planladık.
Yöntemler: Ocak - Aralık 2022 tarihleri arasında nefroloji polikliniğine başvuran renal transplant hastalarının reçeteleri geri dönük incelendi.
Bulgular: Çalışmaya 94 reçete dahil edildi. Araştırmada 94 reçetede toplam 21 majör, 34 orta ve 144 düşük seviyeli etkileşim tespit edildi.
Sonuç: Böbrek nakilli hastalarda ilaç-ilaç etkileşimi asımsanmayacak ölçüde sık görülmektedir. Bu durumun hastaları takip eden hekimler ve eczacılar tarafından bilinmesi ve yeni yazılması planlanan her ilacın ilaç-ilaç etkileşimine yol açıp açmadığının sorgulanması önem taşımaktadır.
Evaluation of Drug-Drug Interactions in Renal Transplant Patients
Introduction: The number of patients with chronic renal failure is increasing day by day throughout the world and in our country. It is also known that these patients have increased mortality and morbidity. As a result, the rate of patients requiring renal replacement therapy is also increasing. Renal transplantation is the treatment method that offers the closest standard of living among renal replacement treatments, and it is also known that this group of patients uses many additional medications along with regular immunosuppressive treatment. In this study, we planned to investigate drug-drug interactions in renal transplant patients with multiple drug use.
Methods: Prescriptions of renal transplant patients who applied to the nephrology outpatient clinic between January and December 2022 were analyzed retrospectively.
Results: 94 prescriptions were included in the study. In the study, a total of 21 major, 34 medium, and 144 low-level interactions were detected in 94 prescriptions.
Conclusion: Drug-drug interactions are extremely common in kidney transplant patients. It is important for physicians and pharmacists who follow the patients to be aware of this situation and to question whether each new drug planned to be prescribed causes drug-drug interaction.
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- 1. Liyanage T, Ninomiya T, Jha V, et al. Worldwide
access to treatment for end-stage kidney disease: a
systematic review. Lancet. 2015; 385:1975-82.
- 2. Böbrek Nakli Yıllara Göre İstatistik Sayfası. Türkiye
Cumhuriyeti Sağlık Bakanlığı. Available at:
https://organkds.saglik.gov.tr/DSS/PUBLIC/Transplant_
Kidney.aspx Accessed September 3, 2023.
- 3. Andacoglu O, Aki FT. Global Perspective on Kidney
Transplantation: Turkey. Kidney360. 2021; 2: 1160-62.
- 4. Kidney transplantation in adults: Overview of care of
the adult kidney transplant recipient. Available at:
https://www.uptodate.com/contents/kidneytransplantation-in-adults-overview-of-care-of-the-adultkidney-transplant-recipient. Accessed September 3,
2023.
- 5. National Institute of Diabetes and Digestive and
Kidney Disease 2019 Annual Data Report. Available at:
https://www.niddk.nih.gov/about-niddk/strategic-plansreports/usrds/prior-data-reports/2019. Accessed
September 3, 2023.
- 6. Chen TK, Knicely DH, Grams ME. Chronic Kidney
Disease Diagnosis and Management: A Review. JAMA.
2019; 322: 1294-304.
- 7. Marquito AB, Fernandes NMDS, Colugnati FAB,
Paula RBD. Identifying potential drug interactions in
chronic kidney disease patients. J Bras Nefrol. 2014; 36:
26-34.
- 8. Shawahna R. Quality Indicators of Pharmaceutical
Care for Integrative Healthcare: A Scoping Review of
Indicators Developed Using the Delphi Technique. Evid
Based Complement Alternat Med. 2020: 9131850.
- 9. Bakker T, Klopotowska JE, de Keizer NF, et al.
Improving medication safety in the Intensive Care by
identifying relevant drug-drug interactions - Results of a
multicenter Delphi study. J Crit Care. 2020; 57: 134-40.
- 10. Riechelmann RP, Saad ED. A systematic review on
drug interactions in oncology. Cancer Invest. 2006; 24:
704-12.
- 11. Riechelmann RP, Moreira F, Smaletz O, Saad ED.
Potential for drug interactions in hospitalized cancer
patients. Cancer Chemother Pharmacol. 2005; 56: 286-
90.
- 12. Moradi O, Karimzadeh I, Davani-Davari D,
Shafiekhani M, Sagheb MM, Raees-Jalali GA. DrugDrug Interactions among Kidney Transplant Recipients
in The Outpatient Setting. Int J Organ Transplant Med.
2020; 11: 185-95.
- 13. Hosohata K, Masuda S, Katsura T, et al. Impact of
intestinal CYP2C19 genotypes on the interaction
between tacrolimus and omeprazole, but not
lansoprazole, in adult living-donor liver transplant
patients. Drug Metab Dispos 2009; 37: 821-6.
- 14. Pascual J, del Castillo D, Cabello M, et al.
Interaction between everolimus and tacrolimus in renal
transplant recipients: a pharmacokinetic controlled trial.
Transplantation. 2010; 89: 994-1000.
- 15. Maguire M, Franz T, Hains DS. A clinically
significant interaction between tacrolimus and multiple
proton pump inhibitors in a kidney transplant recipient.
Pediatr Transplant 2012; 16: E217-20.
- 16. Flothow DJG, Suwelack B, Pavenstädt H, SchütteNütgen K, Reuter S. The Effect of Proton Pump Inhibitor
Use on Renal Function in Kidney Transplanted Patients.
J Clin Med. 2020; 9: 258.
- 17. Zhao W, Baudouin V, Fakhoury M, Storme T,
Deschênes G, Jacqz-Aigrain E. Pharmacokinetic
interaction between tacrolimus and amlodipine in a renal
transplant child. Transplantation. 2012; 93: e29-e30.
- 18. Zuo XC, Zhou YN, Zhang BK, et al. Effect of
CYP3A5*3 polymorphism on pharmacokinetic drug
interaction between tacrolimus and amlodipine. Drug
Metab Pharmacokinet. 2013; 28:398-405.
- 19. Seifeldin RA, Marcos-Alvarez A, Gordon FD, Lewis
WD, Jenkins R. Nifedipine interaction with tacrolimus in
liver transplant recipients. Ann Pharmacother. 1997; 31:
571-5.
- 20. Yang Y, Huang X, Shi Y, et al. CYP3A5 GenotypeDependent Drug-Drug Interaction Between Tacrolimus
and Nifedipine in Chinese Renal Transplant Patients.
Front Pharmacol. 2021;12:692922.